The world of insurance billing is more complicated for holistic practices. Accurate coding and billing practices ensure a smooth reimbursement process, allowing the practice to get paid while providing the best care to patients.

The majority of medical procedures performed by healthcare providers are documented using Current Procedure Terminology, or CPT codes. These medical billing codes identify the type of procedure being performed, allowing providers to bill insurance companies and receive reimbursements for administered services.

Acupuncture practices use codes that match the services they provide. CPT codes 97810-97814 for acupuncture are part of the American Medical Association's (AMA) Current Procedural Terminology (CPT) code set for medical services and procedures. To bill insurance for acupuncture services, four codes cover the majority of services. Electrical stimulation will necessitate the revision of acupuncture CPT codes.



The CMS announced on January 21st, 2020, that Medicare and Medicaid will now cover chronic low back pain. This term refers to lower back pain that has persisted for over three months. Despite this ruling, several conditions must be met before Medicare will cover acupuncture services.

The following acupuncture billing codes are currently covered by Medicare guidelines.

Acupuncture CPT code 97810 requires a 15-minute needle insertion time and one-on-one time with the patient.

According to CTP code 97811, after the first 15 minutes, use one unit for every 15 minutes of personal one-on-one contact with the patient, including needle re-insertion.

CTP code 97813 specifies a needle insertion time of 15 minutes and one-on-one contact with the patient.

CTP code 97814 allows for one unit to be used for every 15 minutes of additional one-on-one contact with the patient, including needle re-insertion.

Acupuncture CPT Codes Billing Guidelines


CPT 97810

Hand cleansing, site selection, cleaning, insertion/stimulation/removal/property disposal are all included in intraservice treatment times. Therapists evaluate treatment effectiveness, interact with patients and families (including education, discussion, and counseling), and plan for future therapy sessions.

These methods demonstrate the importance of daily evaluation in acupuncture treatment. A re-examination typically takes 30 days to complete. A 30-day re-evaluation of acupuncture may necessitate traditional procedures as well as the usual day-to-day assessment, for example, if the patient receives a new diagnosis or if the patient's condition changes unexpectedly.

Consider categorizing E&M services when a patient's distinct possibility necessitates additional E&M services beyond the typical pre- and post-acupuncture evaluation and management work. Such situations are all too common.

CPT 97811

For groups that have purchased the acupuncture rider or have an acupuncture benefit, acupuncture is a covered benefit. Acupuncture benefits are mentioned in subscriber agreements, benefit booklets, and proof of coverage.

Acupuncturists use needles to insert into the skin at specific points on the body to produce anesthesia, relieve pain, treat various non-painful ailments, and alleviate opiate withdrawal symptoms.

CPT 97813

Initial Acupuncture with Electrical Stimulation (97813) Office visits, also known as assessment and management services, may be charged for the initial patient evaluation. A good rule of thumb is to visit every 30 days or every six visits.

Billing these CPT codes each time a patient receives acupuncture is ineffective because each day's therapy includes evaluation and management. Acupuncture has four CPT codes for this.

When you first see a patient, bill a new patient visit code using Acupuncture CPT codes 99201 through 99204. A "new patient" is someone who joins your practice after not seeing you or another specialist in your specialty in the previous three years.

CPT 97814

Insurance billing for holistic practices adds another layer of complexity. The vast majority of medical procedures performed by healthcare professionals may be documented using CPT codes. Doctors can use these medical billing codes to properly bill insurance companies and get reimbursed for their services.

Acupuncture clinics frequently use unique identifiers for their services. Because treatments are frequently tagged in 15-minute intervals, acupuncture CPT codes will differ in duration, so one code will be used for the first 15 minutes of service and another for the next 15 minutes.

CPT codes can be used to document the vast majority of medical procedures performed by health care practitioners. Doctors can use these medical billing codes to bill insurance companies and receive reimbursement for their services.

For their services, acupuncture clinics frequently use distinct identities. Because services are frequently coded in 15-minute increments, you'll need one code for the first 15 minutes and a different code for each subsequent unit of time. You must use electrical stimulation to update your acupuncture CPT codes.

CPT codes for acupuncture treatments, office visits, and physical therapy-based treatments and modalities may be organized according to your practice's three primary revenue sources. Remember that your patient's insurance coverage is determined by the plan and the employer; simply knowing the name of the insurance company is insufficient.

Always confirm your patient's benefits with the payer before beginning treatment when billing insurance for acupuncture. Acupuncture is subject to Medicare requirements as well.

To bill acupuncture treatments, your practice will use one code for the first 15 minutes and a different code for each subsequent visit. If you use electrical stimulation, you can only change your acupuncture billing codes.

Continue to use one unit for every 15 minutes of personal connection and needle re-insertion with the patient after the initial 15 minutes. When combined with 97813, this item yields the same results as 97810.

 

Evaluation and management are included in the Acupuncture CPT codes 97810 through 97814 as part of the total daily therapy. It is not appropriate to charge these codes to every single patient who receives acupuncture. A physician should thoroughly review the patient's file, an interim history, and any necessary physical examination and assessment before seeing the patient in person. Interservice treatment times include hand washing, site selection, cleanliness, insertion/stimulation/removal/property disposal.

Therapists conduct post-service evaluations of treatment effectiveness, communicate with patients and families (including education, discussion, and counseling), and plan for future therapy sessions as part of their post-service activities. These protocols demonstrate the importance of daily evaluation in acupuncture treatment. A re-examination, in addition to the routine day-to-day assessment, takes about 30 days to complete.

Keep visiting the blog for more Billing and coding information.

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