Acupuncture PC/PIs

Acupuncture Practice Competencies and Performance Indicators (APC/PIs) for Massage Therapy

CMTO’s Acupuncture Practice Competencies and Performance Indicators (APC/PIs) define the entry-level acupuncture practice requirements for Registered Massage Therapists (RMTs). The APC/PIs were approved by Council on February 12, 2013. An updated version was approved by CMTO’s Executive Committee on August 15, 2016. The project approach, under the expert facilitation of Dr. David Cane, was similar to the one used in the Inter-jurisdictional Practice Competencies and Performance Indicators project.

A five-person project team made up of RMTs with expertise in acupuncture practice and education was selected by the College. The team members were:

Brandy John, RMT; Marylou Lombardi, RMT; Dennis Newhook, RMT; David Schroevalier, RMT; Jessica Watson, RMT.

The project team developed 31 proposed practice competencies for acupuncture, organized within the following areas of practice:

  • Foundational Knowledge
  • Treatment Planning
  • Treatment
  • Risk Management

In order to enable CMTO to update its process of review and approval for acupuncture education programs, the team went on to develop several performance indicators for each competency. The indicators provide a direct link between the competencies required in practice and program curriculum. The initial list contains 75 indicators.

The APC/PIs will now form the basis for CMTO to develop a more comprehensive acupuncture strategy that may include:

  • enhanced communication with registrants about the requirements for practising acupuncture
  • review and revision of the CMTO Standards of Practice for acupuncture
  • developing an updated process for approving acupuncture education programs
  • revising the process for authorization of RMTs to perform acupuncture
  • incorporating an acupuncture component into the quality assurance process

Massage Therapists may only practise acupuncture within the Scope of Practice of Massage Therapy. Many acupuncture programs teach competencies for conditions which exceed the Massage Therapy Scope of Practice. Massage Therapists must familiarize themselves with the APC/PIs for Massage Therapy and only apply them within the Massage Therapy Scope of Practice. If Massage Therapists wish to provide the full breadth of acupuncture care, they will need to become registrants of the College of Traditional Chinese Medicine Practitioners and Acupuncturists.

View the APC/PIs here.

Joint Fact Sheet on: Acupuncture Treatment Provided by Registered Massage Therapists (RMT)

A joint fact sheet by CMTO and the RMTAO has been developed to respond to various questions both the public and registrants have regarding the provision of acupuncture by RMTs.

Information for the Public

Can a Registered Massage Therapist Perform Acupuncture?

Yes, acupuncture can be used by RMTs if it is provided within the Scope of Practice of Massage Therapy. It can be used safely and effectively as an adjunct to the other techniques and treatments that are within an RMT’s scope of practice. These RMTs are not called acupuncturists but rather use acupuncture as a modality or tool within their massage therapy practice, sometimes choosing acupuncture points based on their knowledge of anatomy, physiology and pathology, combined with their acupuncture training.

Is Acupuncture within the Scope of Practice for a Registered Massage Therapist?

Yes, an RMT may use acupuncture as part of their massage therapy treatment. Massage Therapy is the assessment of the soft tissue and joints of the body, the treatment and prevention of physical dysfunction and pain of the soft tissues and joints by manipulation to develop, maintain, rehabilitate or augment physical function, or relieve pain. An RMT must first conduct an assessment and determine if acupuncture is an appropriate treatment for the client’s condition. If so, the RMT will incorporate acupuncture into the treatment plan and it becomes a modality or tool used in treatment. The treatment provided is deemed Massage Therapy and is not considered stand-alone acupuncture.

As RMTs can only practice acupuncture within their scope of practice, they cannot use it to treat those conditions or issues outside of their scope, e.g. addiction cessation. Although many educational programs teach acupuncture for conditions which exceed the Massage Therapy scope of practice, an RMT who wishes to provide the full breadth of acupuncture care must also be registered with the College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario. Care for conditions outside the Massage Therapy Scope of Practice would not be considered Massage Therapy treatment. RMTs found to be practicing either Traditional Chinese Medicine or acupuncture techniques beyond the scope of practice of Massage Therapy risk being charged with holding themselves out as a CTCMPAO registrant. In addition, they could be subject to professional misconduct proceedings at CMTO.

RMTs who provide acupuncture must:

  • Follow the College’s Code of Ethics, the Standards of Practice, and the Regulations,
  • Conduct an initial client assessment and determine the appropriateness of acupuncture in their treatment planning,
  • Ensure that they have the knowledge, skill and judgment to perform acupuncture competently,
  • Explain the potential risks and benefits of acupuncture to the client so that s/he can make an informed decision,
  • Obtain valid consent before beginning treatment, and
  • Continually evaluate the effects of acupuncture on the client’s condition and overall health.

What is meant by a “modality”?

A modality is a type of treatment or a tool used to treat a condition. There are a number of modalities that can be integrated into a Massage Therapy treatment plan that are taught outside of the entry to practice competencies. These include, but are not limited to: acupuncture, manual lymph drainage, ART, Aquatic Massage Therapy, and other similar forms of manual therapy.

RMTs have a professional responsibility to practice within the scope of practice for Massage Therapy and to ensure that they make no unverified claims regarding the effects of any treatment modality they use.

Do Registered Massage Therapists require additional education to provide acupuncture?

Yes, RMTs must obtain additional education and are not permitted to practice acupuncture without verification of completion of training approved by the College, as outlined in the College’s Standard of Practice for Acupuncture. The College recently adopted practice competencies and performance indicators for acupuncture. Educational programs in acupuncture will be reviewed to ensure that they meet these competencies. The College is currently determining what will be required for RMTs to demonstrate their knowledge and skills in the acupuncture practice competencies. The Peer Assessment component of the Quality Assurance Program will also be reviewed to determine what adjustments need to be made in order to permit assessment of acupuncture related activities.

What if a Registered Massage Therapist is also registered in another health profession that can provide acupuncture?

When a health professional is registered in more than one profession, there is potential for clients to be misled about the qualifications or role of the health care provider. RMTs must give careful consideration to whether they are using their additional skills and knowledge within the scope of practice of Massage Therapy. In some circumstances, it would be appropriate to separate the practices to avoid confusion by clients as to which of the two professions the health care provider is practicing. If the health professional is practicing in a solo practice, it would be considered best practice to maintain separate treatment and financial records for both professions so that there can be no confusion as to when the practitioner is practicing which profession. For more information on dual registration, please refer to the Dual Registration page

Can I be reimbursed by my extended health coverage for acupuncture provided by a RMT?

Absolutely, acupuncture provided by a Registered Massage Therapist (RMT) as part of a Massage Therapy treatment is covered by any extended health insurance that covers massage therapy. When an RMT provides acupuncture as part of a Massage Therapy treatment, a receipt is provided that can be used to seek reimbursement the same as any other Massage Therapy treatment. This receipt will indicate that massage therapy was provided and can be reimbursed as massage therapy by extended health insurance.

Can an RMT issue a separate receipt for the provision of acupuncture?

Usually not. Acupuncture provided by a Registered Massage Therapist (RMT) as part of a massage therapy treatment is billed and reimbursed as massage therapy. This is a billing requirement of RMTs’ regulatory college, the College of Massage Therapists of Ontario (CMTO). If an RMT is also registered as another regulated health care practitioner able to practice acupuncture, such as an Acupuncturist, they may be able to provide stand-alone acupuncture treatments that are billed and reimbursed as acupuncture.

Information for Registered Massage Therapists

Is additional professional liability insurance needed when providing acupuncture as an RMT?

Yes, the Professional Liability Insurance (PLI) commonly used by Registered Massage Therapists (RMT) does not cover the use of acupuncture without purchasing additional insurance coverage specifically for the use of acupuncture as a massage therapy modality. Please contact your PLI provider for more information on adding acupuncture modality coverage to your insurance. The amount of acupuncture liability coverage needed may depend on the proportion of acupuncture provided in your practice; higher proportions of acupuncture modality use may require increased insurance premiums.

Further PLI coverage is also needed if an RMT would like to become a dual registrant with the College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario (CTCMPAO) as an Acupuncturist. This insurance may be in addition to acupuncture modality coverage, already purchased due to the specific requirements of the CTCMPAO and the insurance packages available.