{"id":4584,"date":"2025-08-29T13:58:26","date_gmt":"2025-08-29T13:58:26","guid":{"rendered":"https:\/\/medibillmd.com\/blog\/?p=4584"},"modified":"2025-08-29T13:58:27","modified_gmt":"2025-08-29T13:58:27","slug":"cpt-code-97813","status":"publish","type":"post","link":"https:\/\/medibillmd.com\/blog\/cpt-code-97813\/","title":{"rendered":"Ultimate Guide to CPT Code 97813"},"content":{"rendered":"\n<p>Repeatedly using the wrong code for billing an acupuncture service? Use CPT code 97813 for an acupuncture with electrical stimulation! With only four specific codes, acupuncture billing should be very easy, right? However, it is quite the opposite. Many licensed acupuncturists often misreport their services due to a lack of coding expertise and knowledge.<\/p>\n\n\n\n<p>The end result? Continuous denials! For a smooth billing process, you must understand that each code has distinct rules and requirements. Today, we will simplify one of the primary acupuncture codes (97813). So, without further ado, let\u2019s start with its description.<\/p>\n\n\n\t\t\t\t<div class=\"wp-block-uagb-table-of-contents uagb-toc__align-left uagb-toc__columns-1 uagb-toc__collapse uagb-block-572db062      \"\n\t\t\t\t\tdata-scroll= \"1\"\n\t\t\t\t\tdata-offset= \"30\"\n\t\t\t\t\tstyle=\"\"\n\t\t\t\t>\n\t\t\t\t<div class=\"uagb-toc__wrap\">\n\t\t\t\t\t\t<div class=\"uagb-toc__title\">\n\t\t\t\t\t\t\tTable Of Contents\t\t\t\t\t\t\t\t\t\t\t\t\t<svg xmlns=\"https:\/\/www.w3.org\/2000\/svg\" viewBox= \"0 0 384 512\"><path d=\"M192 384c-8.188 0-16.38-3.125-22.62-9.375l-160-160c-12.5-12.5-12.5-32.75 0-45.25s32.75-12.5 45.25 0L192 306.8l137.4-137.4c12.5-12.5 32.75-12.5 45.25 0s12.5 32.75 0 45.25l-160 160C208.4 380.9 200.2 384 192 384z\"><\/path><\/svg>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"uagb-toc__list-wrap \">\n\t\t\t\t\t\t<ol class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#cpt-code-97813-description\" class=\"uagb-toc-link__trigger\">CPT Code 97813 \u2013 Description<\/a><li class=\"uagb-toc__list\"><a href=\"#scenarios-where-cpt-code-97813-is-applicable\" class=\"uagb-toc-link__trigger\">Scenarios Where CPT Code 97813 is Applicable<\/a><ul class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#treating-chemotherapy-induced-nausea-or-vomiting-cinv\" class=\"uagb-toc-link__trigger\">Treating Chemotherapy-Induced Nausea or Vomiting (CINV)<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#reducing-the-intensity-of-medicine-resistant-chronic-migraine\" class=\"uagb-toc-link__trigger\">Reducing the Intensity of Medicine-Resistant Chronic Migraine<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#easing-chronic-obstructive-pulmonary-disease-copd-symptoms\" class=\"uagb-toc-link__trigger\">Easing Chronic Obstructive Pulmonary Disease (COPD) Symptoms<\/a><\/li><\/ul><\/li><li class=\"uagb-toc__list\"><a href=\"#applicable-modifiers-for-cpt-code-97813\" class=\"uagb-toc-link__trigger\">Applicable Modifiers for CPT Code 97813<\/a><ul class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#modifier-ga\" class=\"uagb-toc-link__trigger\">Modifier GA<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#modifier-gp\" class=\"uagb-toc-link__trigger\">Modifier GP<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#modifier-gy\" class=\"uagb-toc-link__trigger\">Modifier GY<\/a><\/li><\/ul><\/li><\/ul><\/li><li class=\"uagb-toc__list\"><a href=\"#cpt-code-97813-billing-reimbursement-guidelines\" class=\"uagb-toc-link__trigger\">CPT Code 97813 \u2013 Billing &amp; Reimbursement Guidelines<\/a><ul class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#use-cpt-code-97813-for-electroacupuncture\" class=\"uagb-toc-link__trigger\">Use CPT Code 97813 for Electroacupuncture<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#use-this-code-to-bill-the-first-15-minutes\" class=\"uagb-toc-link__trigger\">Use this Code to Bill the First 15 Minutes<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#document-the-medical-necessity-of-electroacupuncture\" class=\"uagb-toc-link__trigger\">Document the Medical Necessity of Electroacupuncture<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#verify-payer-specific-rules\" class=\"uagb-toc-link__trigger\">Verify Payer-Specific Rules<\/a><\/li><\/ul><\/li><\/ul><\/li><\/ul><\/li><li class=\"uagb-toc__list\"><a href=\"#summary\" class=\"uagb-toc-link__trigger\">Summary<\/a><\/ul><\/ul><\/ul><\/ol>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\n\n\n<div style=\"height:30px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>CPT Code 97813<\/strong><strong> \u2013 Description<\/strong><\/h2>\n\n\n\n<p>As we mentioned earlier, CPT code 97813 refers to a <strong>one-on-one electroacupuncture session<\/strong>. But what does this mean in simple terms? Simply put, this code reports a combination of traditional acupuncture with electrical stimulation.&nbsp;<\/p>\n\n\n\n<p>During this service, a healthcare provider, most likely a licensed acupuncturist, inserts one or more solid, metallic, and fine single-use needles into specific points on the patient\u2019s body. He then attaches a small electrode to the needles, stimulating the nerve endings via electrical pulses to enhance the treatment\u2019s effect.&nbsp;<\/p>\n\n\n\n<p>Like all the other codes in this specialty, the 97813 CPT code is also timed. It means it covers an <strong>initial 15-minute treatment<\/strong> for pain, asthma, stroke, or chemotherapy nausea and vomiting.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Scenarios Where <\/strong><strong>CPT Code 97813 <\/strong><strong>is Applicable<\/strong><\/h2>\n\n\n\n<p>To master any code, you must know when to use it. However, it is not as simple as it seems. To help you with CPT code 97813\u2019s application, here are three detailed, applicable scenarios:<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Treating Chemotherapy-Induced Nausea or Vomiting (CINV)<\/strong><\/h3>\n\n\n\n<p>Nausea and vomiting are one of the most common and distressing side-effects of chemotherapy, affecting up to <a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S2468294225000747\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">80% of cancer patients<\/a>. Acupuncture is usually recommended as a complementary therapy for CINV. Let\u2019s use this information to develop a scenario for the 97813 CPT code.<\/p>\n\n\n\n<p>Suppose a 49-year-old breast cancer patient experiences severe nausea 24 hours after chemotherapy. This nausea lasts up to 5 days after every session with frequent rounds of vomiting. To reduce the severity of CINV, an acupuncturist specially trained in oncology performs electroacupuncture 30 minutes before the patient\u2019s third chemotherapy session. He then bills the initial 15 minutes of this one-on-one treatment with CPT code 97813.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Reducing the Intensity of Medicine-Resistant Chronic Migraine<\/strong><\/h3>\n\n\n\n<p>Did you know that over <a href=\"https:\/\/americanmigrainefoundation.org\/resource-library\/migraine-facts\/\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">37 million people<\/a>, including men, women, and children, in the U.S. suffer from migraines? The numbers are staggering, but the most shocking part is that only a small percentage (5%) of patients receive appropriate care. Several studies suggest that electroacupuncture is the most effective treatment.<\/p>\n\n\n\n<p>So, for our second example, let\u2019s envision a 37-year-old woman with episodic migraines. She endures 3 to 5 migraine days per month by relying on painkillers. However, she finally gives in and visits an acupuncturist after experiencing more frequent headaches with time. Her common symptoms? Throbbing pain on the left side of her head, neck stiffness, and dizziness.<\/p>\n\n\n\n<p>The healthcare provider places several needles at specific pressure points, including the patient\u2019s head, face, and back, and uses electrical pulses to stimulate the nerves. His billing team then uses CPT code 97813 to bill for the first 15 minutes.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Easing Chronic Obstructive Pulmonary Disease (COPD) Symptoms<\/strong><\/h3>\n\n\n\n<p>Electroacupuncture also effectively improves respiratory disorders, especially COPD symptoms. This condition impacts <a href=\"https:\/\/www.lung.org\/research\/trends-in-lung-disease\/copd-trends-brief\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">11.7 million adults in the U.S.<\/a> and is the leading cause of hundreds of thousands of ER visits each year.<\/p>\n\n\n\n<p>So, for the final example of the 97813 CPT code, consider a 41-year-old man with COPD. He opts for acupuncture along with conventional treatment to improve his shortness of breath and chronic cough.<\/p>\n\n\n\n<p>Therefore, the patient visits an acupuncture clinic. After a thorough evaluation, an acupuncturist inserts several thin needles into specific points in the patient\u2019s body and performs electroacupuncture. He then uses CPT code 97813 to bill the first 15 minutes of the session.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Applicable Modifiers for <\/strong><strong>CPT Code 97813<\/strong><\/h2>\n\n\n\n<p>While modifiers are typically not required with CPT code 97813, you can use the following depending on the situation or special circumstances.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Modifier GA<\/strong><\/h3>\n\n\n\n<p><a href=\"https:\/\/www.medicare.gov\/coverage\/acupuncture#:~:text=Medicare%20covers%20up%20to%2012,if%20you%20continue%20getting%20them.\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">Medicare<\/a> offers limited acupuncture coverage for chronic lower back pain (12 sessions in 90 days and an additional 8 sessions if required in a year). Therefore, if you think that it will deny your claim for exceeding 12 sessions within 90 days, apply modifier GA to CPT code 97813.\u00a0<\/p>\n\n\n\n<p>This code will help you inform Medicare that you have issued an Advance Beneficiary Notice (ABN) to the patient, informing them about coverage limitations.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Modifier GP<\/strong><\/h3>\n\n\n\n<p>Was the electroacupuncture you performed part of a physical therapy treatment plan? In that case, append modifier GP to CPT code 97813. This two-character code notifies a payer that a service was either:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Personally delivered by a physical therapist, or<\/li>\n\n\n\n<li>It was performed under an outpatient physical therapy plan of care<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong><a href=\"https:\/\/medibillmd.com\/blog\/modifier-gy\/\" target=\"_blank\" rel=\"noreferrer noopener\">Modifier GY<\/a><\/strong><\/h3>\n\n\n\n<p>Did you perform electroacupuncture on a Medicare beneficiary for an uncovered condition? For example, performing acupuncture with electrical stimulation to treat chemotherapy-induced nausea.&nbsp;<\/p>\n\n\n\n<p>In this case, use modifier GY with CPT code 97813 to indicate that the service is statutorily excluded.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>CPT Code 97813<\/strong><strong> \u2013 Billing &amp; Reimbursement Guidelines<\/strong><\/h2>\n\n\n\n<p>From coverage limitations to changing regulations and coding inaccuracies, acupuncture billing can give you a headache. To improve your overall billing process and accuracy, follow these billing and reimbursement tips for CPT code 97813.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Use <\/strong><strong>CPT Code 97813 <\/strong><strong>for Electroacupuncture<\/strong><\/h3>\n\n\n\n<p>The major difference between CPT code 97813 and 97810 is the use of electrical pulses to improve the benefits of traditional acupuncture. Therefore, only use this code if you have performed electroacupuncture. Otherwise, use CPT code 97810.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Use this Code to Bill the First 15 Minutes<\/strong><\/h3>\n\n\n\n<p>The 97813 is a primary CPT code. Hence, it covers only the first 15 minutes of an electroacupuncture session. For a longer session, use the add-on CPT code 97814 to report each additional 15 minutes you spent treating the patient.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Document the Medical Necessity of Electroacupuncture<\/strong><\/h3>\n\n\n\n<p>As always, complete documentation is necessary for avoiding denials. Therefore, document the electroacupuncture session thoroughly, including:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Duration (start and end time)<\/li>\n\n\n\n<li>Reason for performing the service (patient\u2019s symptoms and diagnosis)<\/li>\n\n\n\n<li>Number of needles and their placement location<\/li>\n\n\n\n<li>Use of electrical stimulation<\/li>\n\n\n\n<li>Patient\u2019s response to treatment<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Verify Payer-Specific Rules<\/strong><\/h3>\n\n\n\n<p>Before filing a claim for any code, make it a habit to verify payer-specific requirements. This step will save you from a lot of billing headaches. Each insurance payer has different coverage rules for CPT code 97813. For example, Medicare covers up to 12 acupuncture sessions in 90 days for only one condition: chronic lower back pain.<\/p>\n\n\n\n<p>It covers 8 more sessions (a total of 20 acupuncture treatments a year). If your patient isn\u2019t showing any improvement, Medicare won\u2019t cover further acupuncture treatments. Moreover, it only pays if a qualified healthcare provider (physician or nurse practitioner) performs the service.&nbsp;<\/p>\n\n\n\n<p>This is just one example. Commercial payers may have completely different requirements. Therefore, confirm their coverage rules before billing for electroacupuncture.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Summary<\/strong><\/h2>\n\n\n\n<p>Do you feel more confident about the time requirements, documentation rules, and payer policies for CPT code 97813? To summarize, this code is quite similar to another primary acupuncture code, CPT code 97810. However, as you might have already gathered from our blog, there is a slight difference. The 97813 CPT code covers acupuncture with electrical stimulation. Hence, use it appropriately.&nbsp;<\/p>\n\n\n\n<p>We have covered this code comprehensively, including three detailed examples, applicable modifiers, and billing tips, because we truly want you to master it. But if you are still wary of ever-changing payer rules, consider a professional to handle your billing.<\/p>\n\n\n\n<p>Many companies, including MediBillMD, offer cost-effective <a href=\"https:\/\/medibillmd.com\/specialties\/acupuncture-billing-services\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>acupuncture billing services<\/strong><\/a>. So, partner with a reliable option to improve your billing accuracy.<\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Repeatedly using the wrong code for billing an acupuncture service? Use CPT code 97813 for an acupuncture with electrical stimulation! [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":4585,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","content-type":"","_uag_custom_page_level_css":"","site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[10],"tags":[],"class_list":["post-4584","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cpt-codes"],"uagb_featured_image_src":{"full":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2025\/08\/CPT-Code-97813.webp",1200,720,false],"thumbnail":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2025\/08\/CPT-Code-97813-150x150.webp",150,150,true],"medium":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2025\/08\/CPT-Code-97813-300x180.webp",300,180,true],"medium_large":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2025\/08\/CPT-Code-97813-768x461.webp",768,461,true],"large":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2025\/08\/CPT-Code-97813-1024x614.webp",1024,614,true],"1536x1536":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2025\/08\/CPT-Code-97813.webp",1200,720,false],"2048x2048":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2025\/08\/CPT-Code-97813.webp",1200,720,false]},"uagb_author_info":{"display_name":"Fred Allen","author_link":"https:\/\/medibillmd.com\/blog\/author\/fred-allen\/"},"uagb_comment_info":0,"uagb_excerpt":"Repeatedly using the wrong code for billing an acupuncture service? Use CPT code 97813 for an acupuncture with electrical stimulation! [&hellip;]","_links":{"self":[{"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/posts\/4584","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/comments?post=4584"}],"version-history":[{"count":0,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/posts\/4584\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/media\/4585"}],"wp:attachment":[{"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/media?parent=4584"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/categories?post=4584"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/tags?post=4584"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}