Struggling with denied claims and underpayments for your acupuncture services? You’re not alone. Many acupuncturists face the frustration of navigating complex CPT codes, leading to lost revenue and unnecessary stress. Accurate billing isn’t just a tedious task—it’s the backbone of your practice’s financial health.
With evolving Medicare rules and insurance guidelines, understanding the correct acupuncture CPT codes has never been more essential. In this guide, we will explore and help you master the codes, avoid costly mistakes, and ensure you get paid for the care you provide.
Primary Acupuncture CPT Codes
Understanding the primary CPT codes for acupuncture is essential for billing accuracy and maximizing reimbursements. These codes categorize services based on the type of acupuncture performed and the time spent with the patient.
Proper usage ensures compliance with Medicare and insurance policies while minimizing claim rejections.
97810: Acupuncture without electrical stimulation, initial 15 minutes.
This code is used for the first 15 minutes of face-to-face patient care during acupuncture sessions without the use of electrical stimulation. It’s the most frequently used code for standalone acupuncture treatments.
97811: Acupuncture without electrical stimulation, each additional 15 minutes.
Use this code when the session extends beyond the initial 15 minutes. It covers re-insertion of needles during the additional time spent with the patient.
97813: Acupuncture with electrical stimulation, initial 15 minutes.
This code is specific to acupuncture treatments involving electrical stimulation. It applies only to the first 15 minutes of contact with the patient.
97814: Acupuncture with electrical stimulation, each additional 15 minutes.
Similar to 97811, this code is for extended sessions involving electrical stimulation, including re-insertion of needles.
Tips for Using These Codes Correctly:
- Only use 97811 or 97814 after the initial 15 minutes covered by 97810 or 97813.
- Document the exact duration and type of service to justify each code.
- Ensure compliance with the number of units allowed by Medicare (e.g., 1 unit for 97810 and 2 units for 97811).
Medicare Guidelines for Acupuncture CPT Codes
Medicare now covers acupuncture treatments for specific conditions, such as chronic low back pain. However, there are stringent guidelines for billing these services. Understanding these rules can help you avoid claim denials.
- Coverage Limits:
Medicare covers up to 12 acupuncture sessions within a 90-day period for chronic low back pain. If the patient shows improvement, an additional eight sessions may be approved, for a maximum of 20 treatments annually.
- MUE Values:
Medically Unlikely Edits (MUE) are guidelines set by the Centers for Medicare and Medicaid Services (CMS) to ensure that the number of units billed for a given procedure does not exceed a medically reasonable amount.
These values are used to determine the maximum units of service that can be billed per date of service, to prevent overbilling and ensure compliance with CMS regulations. For acupuncturists, specific CPT codes have designated MUE values that define how many units can be billed in a single day.
Below is a table of MUE values for common acupuncture codes, according to CMS guidelines.
| S.No | CPT Code | Medically Unlikely Edits (MUE) Values |
| 1 | 20560 | 1 |
| 2 | 20561 | 1 |
| 3 | 97810 | 1 |
| 4 | 97811 | 2 |
| 5 | 97813 | 1 |
| 6 | 97814 | 2 |
| 7 | S8930 | 3 |
Diagnosis Codes:
Ensure the patient’s diagnosis aligns with Medicare-approved conditions. Chronic low back pain is the primary diagnosis currently covered.
Best Practices for Medicare Billing:
- Verify patient eligibility before initiating treatment.
- Maintain detailed documentation of the treatment plan, including progress notes.
- Submit claims promptly to avoid processing delays.
Additional Acupuncture-Related CPT Codes
While the primary codes cover traditional acupuncture treatments, additional CPT codes are often used to bill for complementary therapies. These codes can enhance patient care and diversify your practice offerings.
Manual Therapy Codes:
- 97140: Techniques like mobilization, manipulation, or manual lymphatic drainage.
- 97124: Massage therapy techniques, including effleurage and petrissage.
Therapeutic Procedure Codes:
- 97110: Therapeutic exercises to improve strength, range of motion, and flexibility.
- 97530: Therapeutic activities aimed at enhancing functional performance.
Modalities:
- 97010: Heat therapy using hot or cold packs.
- 97016: Cupping therapy with vasopneumatic devices.
- 97026: Infrared light therapy for pain relief and muscle relaxation.
How to Use These Codes Effectively:
- Pair these codes with acupuncture sessions when appropriate to provide comprehensive care.
- Confirm that insurance covers these additional services, as some modalities may not be reimbursable.
- Clearly document the reason for using complementary therapies and their outcomes.
Acupuncture CPT Codes for Dry Needling
Dry needling, though similar to acupuncture, has distinct CPT codes and billing guidelines. These codes apply to treatments focused on musculoskeletal issues like trigger points.
- 20560: Needle insertion(s) without injection(s); 1-2 muscle(s).
This code is used for treating one or two muscles with dry needling techniques. - 20561: Needle insertion(s) without injection(s); 3 or more muscles.
Use this code when dry needling involves three or more muscles in a single session.
Key Considerations:
- Dry needling is not always recognized as acupuncture by insurance, so coverage may vary.
- Avoid using acupuncture CPT codes (e.g., 97810) for dry needling to prevent claim rejections.
Billing Best Practices for Acupuncture Services
Accurate billing is essential to ensure your practice is reimbursed for the care provided. By following best practices, you can minimize errors and improve your claims success rate.
Common Pitfalls:
- Using the wrong CPT codes for the service performed.
- Exceeding the MUE values for acupuncture treatments.
- Failing to document the patient’s progress or medical necessity for continued care.
Tips for Successful Billing:
- Use billing software to automate coding and detect errors before submission.
- Train staff on the latest CPT codes and Medicare guidelines.
- Double-check claims for compliance with insurance policies.
- Maintain thorough patient records, including session details and outcomes.
Conclusion
Mastering acupuncture CPT codes is vital for ensuring accurate billing and maximizing reimbursements. By understanding Medicare guidelines, using complementary CPT codes effectively, and adopting best practices, you can streamline your billing process and focus on delivering exceptional care. Ready to optimize your acupuncture billing? Take the first step today by implementing these strategies and watch your practice thrive!
Frequently Asked Question
Q 1. What’s the difference between 97810 and 97811?
Ans: 97810 is for the initial 15 minutes without electrical stimulation, while 97811 is for each additional 15 minutes with re-insertion.
Q 2. Can Medicare patients receive acupuncture treatments?
Ans: Yes, for chronic low back pain under specific conditions and limits.
Q 3. How do I document time for acupuncture sessions?
Ans: Record the start and end time of each session, noting any additional treatments like re-insertion of needles.
Q 4. Are dry needling services covered under acupuncture CPT codes?
Ans: No, dry needling has distinct CPT codes (20560, 20561) and is often not covered by insurance.
