Understanding Procedural Terminology (CPT) codes is critical for practitioners of acupuncture to guarantee accurate services and comply with Centers for Medicare and Medicaid Services guidelines in handling insurance claims. This manual offers complete details regarding prior authorization procedures of acupuncture CPT codes as well as their implementation when billing for treatments provided through acupuncture.
Medically Necessary for Acupuncture CPT Codes
Medicare & Medicaid Services eligibility criteria cover acupuncture that’s medically necessary to address low back discomfort. In order for doctors to receive payment under CMS procedures, an authorization request must be filed with an insurance provider. This ensures it will not be denied or rejected and it also allows billing providers to demonstrate that specific health plan insurers approved any proposed treatments before billing proceeds can begin.
Supplemental Acupuncture Benefits
Specific health plans offer additional acupuncture benefits that don’t require prior approval before being claimed. Typically, these benefits don’t need prior authorization unless stipulated by your insurance provider. Healthcare providers should make sure to request such approval early so as not to disrupt customer services and create invoicing issues for themselves and customers alike.
Acupuncture Treatment Process
The typical process for administering acupuncture includes several key steps:
- An assessment of an individual’s medical history and past treatments.
- Analyzing results of previous sessions to inform current treatment plans.
- Selecting specific acupuncture points for each session.
- Documenting all services rendered and discussing them with patients as they occur – along with any follow-up care requirements or potential concerns that might arise – are of utmost importance.
Acupuncture CPT Codes and Billing Guidelines
Billing for acupuncture services requires an in-depth knowledge of CPT codes. These codes can be broken into 15-minute increments for billing purposes, providing a systematic method for you to account for time spent working on one session with each patient.
|
CPT Code |
Time | Service Description |
Medicare Fee 2024 |
| 97810 | Initial 15 minutes | Acupuncture for one or more needles, without electrical stimulation. | $38.28 |
| 97811 | Each additional 15 min | Acupuncture with one or more needles, without electrical stimulation, for each additional 15 minutes, with needle re-insertion. | $28.29 |
| 97813 | Initial 15 minutes | Acupuncture with one or more needles along with electrical stimulation for an initial 15 minutes. | $45.27 |
| 97814 | Each additional 15 min | Acupuncture with one or more needles and electrical stimulation, for every additional 15 minutes, along with needle re-insertion. | $36.62 |
Office Visits Acupuncture CPT Codes CPT Codes for New Patients
- 99201 – Basic Evaluation (Deleted CPT Codes From 01 Jan, 2021)
- Description: This code is used for the management and evaluation of a new patient, which includes a problem-focused history, problem-associated examination, and straightforward medical decision-making.
- Example: A patient visits with minor symptoms like a common cold.
- Time: 10 minutes
- 99202 – Expanded Problem-Focused Evaluation
- Description: This code is more comprehensive and includes an expanded problem-oriented history, a problem-focused examination, and straightforward decision-making.
- Example: A patient comes in complaining of persistent headaches, which are not severe but require a detailed history to assess the pattern.
- Time: 20 minutes
- 99203 – Detailed Evaluation
- Description: Includes detailed history taking, a detailed examination, and low complexity medical decision-making.
- Example: A new patient requires evaluation for moderate abdominal pain that has been persistent for a month.
- Time: 30 minutes
- 99204 – Comprehensive Evaluation
- Description: Used for more complex scenarios, this code includes a comprehensive history, a thorough examination, and medical decision-making of moderate complexity.
- Example: A patient presents with multiple chronic illnesses such as diabetes and hypertension, needing a comprehensive evaluation.
- Time: 45 minutes
Fee Schedule Office Visits Medicare 2024:
The table below gives an overview of the anticipated Medicare fees for each CPT code in 2024:
| CPT Code | Description | Time | Medicare Fee 2024 |
| 99201 | Basic Evaluation | 10m | Deleted CPT Codes From 01 Jan, 2021 |
| 99202 | Expanded Problem-Focused Evaluation | 20m | $72.23 |
| 99203 | Detailed Evaluation | 30m | $111.51 |
| 99204 | Comprehensive Evaluation | 45m | $167.10 |
Acupuncture Physical Therapy Visits
When billing for acupuncture and related therapies, it’s crucial to use the appropriate Current Procedural Terminology (CPT) codes. These codes help categorize services accurately for insurance processing and reimbursement. In this discussion, we will explore various treatments within acupuncture and physical therapy to better understand how each code is applied.
Billing for acupuncture and related therapies requires using Current Procedural Terminology (CPT) codes accurately; these categorize services precisely so insurance processing and reimbursement processes run more smoothly. In this discussion, we’ll review various treatments within both acupuncture and physical therapy that apply each code appropriately.
Detailed Overview of Acupuncture Physical Therapy CPT Codes:
| Therapy Type | CPT Code | Detailed Overview | Example |
| Heat Therapy | 97010 | Use of cold or hot packs applied to some or all of the body. | An individual suffering from lower back pain could benefit from heat therapy to ease muscle tension and improve blood flow. |
| Vasopneumatic Devices | 97016 | Use of devices that create alternate pressure to enhance circulation in targeted areas. | Post-op knee surgery patients could benefit from this therapy to decrease swelling and increase lymphatic drainage. |
| Infrared Therapy | 97026 | Infrared rays used to treat deep tissues by providing warmth and enhancing circulation. | Patients with severe muscle injuries or neuropathies could receive intense heat therapy to increase healing. |
| Therapeutic Exercise | 97110 | Structured exercise programs designed to meet rehabilitation objectives. | A stroke survivor might engage in specific arm-strengthening exercises to regain function. |
| Manual Therapy | 97140 | Techniques including manipulation, mobilization of lymphatic drainage, and manual traction. | People recovering from stroke may perform specific exercises to strengthen arms and restore functionality. |
| Kinetic Activities | 97530 | Dynamic activities aimed at improving patient performance through direct interaction. | An athlete recovering from ankle trauma could practice stability exercises under supervision to enhance rehabilitation. |
Here’s a table summarizing the Medicare fees for these services in 2024.
| CPT Code | Description | Medicare Fee 2024 |
| 97010 | Heat therapy | $6.32 |
| 97016 | Vasopneumatic devices | $11.65 |
| 97026 | Infrared therapy | $6.66 |
| 97110 | Therapeutic exercise | $29.29 |
| 97140 | Manual therapy | $26.96 |
| 97530 | Kinetic activities | $36.62 |
Importance of Knowing CPT Codes
Providers must understand and implement CPT codes correctly. Insurance firms each have specific CPT codes they pay out being aware of them will help guarantee services provided are adequately compensated and minimize billing disputes. By adopting the necessary rules into your practice, this knowledge will facilitate billing procedures while improving patient satisfaction and guarantee compliance with insurance regulations.
Frequently Asked Questions (FAQ):
What are the CPT codes for acupuncture?
The CPT (Current Procedural Terminology) codes commonly used for acupuncture are 97810, 97811, 97813, and 97814. These codes represent different aspects of acupuncture services:
-
-
- 97810: This code is for the first 15 minutes of needle acupuncture where the acupuncturist is with the patient.
- 97811: Use this code for every additional 15 minutes the acupuncturist spends during a needle acupuncture session. This is added to the first code.
- 97813: This code is similar to 97810 but includes electrical stimulation during the first 15 minutes.
- 97814: Like 97811, but for additional time when electrical stimulation is also used during the acupuncture.
-
What is CPT code 97813 and 97814?
-
-
- 97813: For the initial 15 minutes of acupuncture with electrical stimulation.
- 97814: For each extra 15 minutes of acupuncture if electrical stimulation is used.
-
What is CPT code 97813 for acupuncture?
CPT code 97813 can be applied to acupuncture treatments that include electrical stimulation during the initial 15 minutes of direct, intimate contact between client and practitioner. The code forms part of a set of codes used to categorize these kinds of services. Specifically, how the use of electrical stimulation enhances therapeutic effects during treatments.
What is CPT code 97140 for acupuncture?
CPT code 97140 pertains to manual therapy techniques like massage and manipulation. It’s not connected specifically with acupuncture practice; if your therapy sessions incorporate both types of services however, use CPT 97140 only when billing for manual therapy alone and not concurrently with codes used for Acupuncture services.
What are acupuncture CPT code Modifiers?
59: Distinguishes a service that is not typically reported together but is appropriate under the circumstances.
51: Indicates multiple procedures.
25: Signifies a significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service.
XS, -XP, -XU, -XE (Subset of -59): Specify different subsets of the -59 modifier to provide more detail about the non-typical procedures.
