Acupuncture Billing and Coding: Everything You Need to Know to Transform Your Bottom-line!
- SolvEdge
- May 06, 2021
- 4 mins read
Acupuncture billing and coding is among the key specialty billing that involve several complexities that result from constantly varying codes and wide variety of treatments that differ from clinic to clinic. Though pain-related acupuncture treatment is the most common form of treatment that acupuncturists undertake, there are other conditions that some of the Physicians treat, including chronic diseases, dental, mental health, asthma, etc.
With innumerable variations and complexities involved in the process, billing guidelines and regulatory compliance are not among the top priorities for the Practitioners. This blog aims to Simplify Healthcare Experiences for Acupuncture practitioners by breaking down the intricacies and the nuances of Acupuncture billing and how healthcare organizations can optimize their financial performance.
| CPT Code | Description |
|---|---|
| 20560 | Needle insertion(s) without injection(s), 1-2 muscles; describes the work of dry needling to 1 or 2 muscles |
| 20561 | 3 or more muscles; describes the work of dry needling to 3 or more muscles |
| 97014 | Supervised electric stimulation, application of a modality to one or more areas |
| 97032 | Attended manual electric stimulation; requirement for constant attendance is derived from the manual-application requirement |
| 97810 | Acupuncture, one or more needles, without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient |
| 97811 | Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles |
| 97813 | Acupuncture, one or more needles, with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient |
| 97814 | Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles |
| 97032 | Attended manual electric stimulation; requirement for constant attendance is derived from the manual-application requirement |
| HCPCS Code | Description |
| A4212 | Noncoding needle or style |
| A4215 | Needle, sterile |
| G0283 | Electrical stimulation (unattended) |
| S8930 | Electrical stimulation of auricular acupuncture points |
In accordance with the code descriptions and/or the Centers for Medicare and Medicaid Services (CMS) guidelines and CMS Medicaid National Correct Coding Initiative (NCCI) established Medically Unlikely Edits (MUE) values, the maximum units of acupuncture services allowed per date of service are as below.
| 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 |
Acupuncture Billing Guidelines
Medically Necessary Acupuncture benefits are available for patients that meet the Centers for Medicare & Medicaid (CMS) criteria for Chronic Lower Back Pain. To determine qualification, a request for prior authorization must be submitted. Supplemental acupuncture benefits are available for patients enrolled in a participating plan. Generally, these services do not require prior authorization unless mandated by the health plan.
Acupuncture Treatments include
a review of the patient’s chart,
obtaining a brief account of the results of the previous treatment
selecting points for the day’s treatment, and
post service documentation and consultation.
| CPT Code | Description |
|---|---|
| 97110 | Therapeutic Exercise |
| 97140 | Manual Therapy |
| 97112 | Neuromuscular Re-Education |
| 97530 | Therapeutic Activities |
| 97010 | Hot/Cold Packs |
| 97014 | Electrical Stimulation (Unattended) |
| G0283 | Electrical Stimulation, Medicare Non-Wound (Unattended) |
| 97035 | Ultrasound / Phonophoresis |
| 97161 | PT Evaluation: Low Complexity |
| 97162 | PT Evaluation: Moderate Complexity |
| 97116 | Gait Training |
| 97535 | Self-Care / Home Management Training |
| 97016 | Vasopneumatic Device |
| 92507 | SLP Treatment; Individual |
| 97032 | Electrical Stimulation (Manual) |
| 97164 | PT Re-Evaluation |
| 97012 | Mechanical Traction |
| 97150 | Group Therapy |
| 97113 | Aquatic Therapy / Exercise |
| 97124 | Massage Therapy |
Final Words
With innumerable complications involved in acupuncture therapies, Practitioners face major challenges with acupuncture billing and coding. At SolvEdge, we simplify healthcare financial experiences for our clients by staying on top of the constantly evolving regulations, state-wise rules, HIPPA guidelines and much more. Our certified and experienced team of coders and billing experts are dedicated to increasing Practice revenues, while preventing losses.
Our SMEs, technologists and strategists work together to save clients’ time, mitigate errors, reduce appeals and re-filing—thereby saving millions of dollars of lost revenues.
Get started with our No Cost Gap Analysis to evaluate your missed out payments and recoup your lost revenues with our medical billing experts. Give us a shout!
