The administrative side of running an acupuncture practice can often feel overwhelming. However, a thorough understanding of the acupuncture CPT codes is crucial for financial success. Moreover, staying informed about the relevant guidelines will be key to efficient billing and revenue cycle management. This guide aims to cover both!
That is, we will discuss the primary CPT codes for acupuncture and provide insight into the billing and reimbursement guidelines. Thus, read this guide till the end to equip yourself with the necessary skills.
Essential CPT Codes for Acupuncture
The following are the primary acupuncture CPT codes:
CPT Code 97810 – Acupuncture Treatment, Initial 15 Mins
This CPT code for acupuncture covers the initial 15 minutes of therapeutic intervention treatment. The acupuncturist uses single-use, solid, metallic, fine needles to pierce the patient’s skin. He then manipulates the needles by hand to stimulate anatomical points on or in the skin.
Physicians may order this procedure for either of the following:
- Treatment of postoperative and chemotherapy vomiting and nausea.
- Asthma treatment.
- Prevention or relief of pain.
- Treatment of addiction, asthma, and other conditions.
An Example
Picture a 50-year-old male patient who recently encountered a minor injury and visits the acupuncture clinic. He complains about persistent shoulder pain and limited range of motion.
The acupuncturist performs an initial assessment and determines that manual acupuncture is an appropriate treatment modality.
Based on the assessment, the acupuncturist proceeds with manual acupuncture. The provider carefully inserts single-use, sterile, fine needles at specific acupuncture points on the patient’s affected shoulder and nearby areas. He then manually manipulates the needles to achieve the desired therapeutic sensation.
CPT Code 97811 – Acupuncture Treatment, Additional 15 Mins
What happens when the acupuncturist spends more than 15 minutes performing the therapeutic intervention described in CPT 97810? The acupuncturist reports acupuncture CPT code 97811 to bill for each additional 15 minutes of patient contact.
An Example
Assume the same scenario we discussed in CPT 97810. Following the initial 15 minutes, the acupuncturist continues the manual acupuncture treatment for an additional 25 minutes.
The provider maintains manual stimulation of the needles at the previously inserted points. It further addresses the patient’s shoulder pain and improves his range of motion.
The acupuncturist bills two units of CPT 97811 with CPT 97810 based on the Medicare 8-minute rule.
CPT Code 97813 – Electrical Acupuncture, Initial 15 Mins
This CPT code for acupuncture covers the electroacupuncture procedure for an initial 15 minutes.
How does it work? The acupuncturist uses single-use, solid, metallic, fine needles to pierce the patient’s skin, just like CPT 97810. However, instead of manual stimulation, he uses electrical stimulation to activate or unblock anatomical points on or in the skin.
An Example
Imagine a 60-year-old female patient, with persistent gut issues after surgery, visits the acupuncture clinic. After an initial evaluation, the acupuncturist recommends electroacupuncture as a potential treatment.
Therefore, the acupuncturist starts the electroacupuncture session. The provider inserts single-use, sterile, fine needles at specific acupuncture points on the patient’s abdomen, ankles, hands, and legs. These points are known to be effective for digestive relief. The provider delivers gentle electrical current using small electrostimulation devices connected to needles for stimulation.
CPT Code 97814 – Electrical Acupuncture, Additional 15 Mins
It is an add-on acupuncture CPT code. There may be scenarios where a patient requires electroacupuncture treatment beyond the initial 15 minutes. The acupuncturist can report CPT code 97814 to bill for each additional 15 minutes of the treatment.
An Example
So, when do we use this CPT code for acupuncture? Let’s go back to our previous example, the one used to explain CPT 97813. Consider that the acupuncturist continues the electroacupuncture session for an additional 40 minutes to treat digestive issues.
The provider adjusts the frequency and intensity of the electrical current based on the patient’s response. The extra time further eases her nausea, constipation, and bloating.
The 8-minute rule for reimbursement applies here. Therefore, the acupuncturist should report three units of CPT code 97814 with CPT 97813.
Acupuncture CPT Codes – Billing & Reimbursement Guidelines
Discussed below are some of the billing and reimbursement requirements related to the CPT codes for acupuncture.
Accurately Monitor and Document Time
All primary acupuncture CPT codes are time-based. You can bill these codes in 15-minute increments for in-person, one-on-one contact with the patient. It involves time spent on needle insertion, manipulation, assessment, and discussion.
You can report the initial code (CPT code 98710 or 98713) only once for the initial 15 minutes of service. You should report the additional time in 15-minute increments with the add-on codes (98711 and 98714). Besides, you must calculate the billable units of add-on code based on the Medicare 8-minute rule.
Ensure Comprehensive Documentation
Detailed documentation is key to demonstrating the medical necessity of the acupuncture session. Your documentation should also support why you billed a certain number of units of the add-on CPT codes for acupuncture.
Here’s a list of some things your documentation must include:
- Medical indication and patient diagnosis.
- Details about the specific acupuncture points treated.
- The number of needles used.
- The type of stimulation utilized (electrical or manual).
- The total time spent with the patient (in-person/ one-on-one contact).
- The patient’s response to the treatment.
Understand the Specific Payer Policies
Reimbursement guidelines vary significantly from payer to payer. Therefore, we recommend acquiring prior authorization before rendering services. Moreover, establish open lines of communication with the payer to understand billing limitations when it comes to billing CPT codes for acupuncture.
MediBillMD: Your Dedicated Solution for Stress-Free Acupuncture Billing
With this guide as your go-to resource, you can easily win over the intricacies of acupuncture billing. We covered the primary acupuncture CPT codes, including 98710, 98711, 98713, and 98714. Additionally, we discussed the billing and reimbursement guidelines.
Managing medical coding and billing is not a piece of cake. If not done right, you can lose your rightful reimbursements due to a higher denial rate. Thus, you should partner with professionals if you cannot handle it in-house or hire certified professional coders (CPCs) for specialty medical billing. MediBillMD, a leading medical billing company, can help you. Outsource your acupuncture billing services to our professional team so you can focus on quality patient care.
