The regulation of acupuncture practice in the United States is highly decentralized, resulting in significant variation in licensure and scope of practice across the fifty states. This regulatory fragmentation affects both the level of training required and the specific techniques a practitioner is legally permitted to employ.

In many states, the most highly trained professional is the Licensed Acupuncturist (LAc), who has completed thousands of hours of training and passed national certification exams (NCCAOM). However, a separate category often exists for the Physician Acupuncturist, who is a medical doctor permitted to practice the modality within their primary medical license after completing a shorter course of specialized instruction (often 200–300 hours). The specific scope of practice—which defines whether an LAc can recommend and dispense herbal remedies, use Tui Na (Chinese manipulative therapy), or perform certain diagnostic assessments—differs dramatically by state statute. This variance in legal authority necessitates that practitioners must adhere to the specific rules of the jurisdiction in which they practice, which can create complexity when offering integrated care or moving between states. This jurisdictional variation in professional authority is a key consideration for both practitioners and patients, as highlighted in regulatory reviews, such as the US Acupuncture Professional Insights.