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Acupuncture Billing FAQ: Top Questions and Answers

Over the last few years, more people than ever before are turning to acupuncture and other holistic treatments to alleviate ailments. As more people intentionally seek this service, your practice is likely to grow in size as members of your community begin to visit.

With this exciting growth in business comes the not-so-exciting amounts of medical billing paperwork - not to mention the headache of it all! Holistic Billing Services knows medical billing can be a challenge to navigate, especially for acupuncture practices. This post addresses some of the most frequently asked questions about billing for acupuncture to equip you with the fundamentals of medical billing.

What is Medical Billing?

Medical billing involves a healthcare provider submitting, following up on, and appealing claims with health insurance companies in order to receive payment for services rendered; such as testing, treatments, and procedures. It can be a long, grueling process that requires jumping through hoops left and right to receive payment for services rendered.

Why Is Medical Billing Important for Acupuncture Practices? Acupuncture Practices

Though it may be a complicated process, it is also absolutely necessary for acupuncture practices because it is the most common way of getting paid for services rendered. The majority of your patients will likely have some form of insurance as payment, so your practice needs to be adept at navigating the many facets of dealing with insurance companies. This includes being knowledgeable of the appropriate medical billing codes for the treatment you provide to your patients, keeping track of the relevant patient records, and understanding how to communicate with the insurance company in order to be reimbursed.

Top Acupuncture Billing Questions and Answers

Medical billing can be a challenging portion of your acupuncture practice’s administrative needs. Let’s review some of the top acupuncture billing questions with our expert answers:

When Should I Update My Insurance Verifications and Medical Credentials?

Insurance verification is a critical component of billing insurances for acupuncture, and medical credentialing is a key part of this, too. Current verifications have the strongest correlation with successfully getting claims paid, which is obviously essential to your acupuncture practice. Patient plans and/or benefits will often change at the start of a new year, so it’s imperative you request new insurance verifications as soon as the new calendar year starts.

I am In-Network for a Couple of Insurance Companies, How Often Should I Re-Negotiate My Rates?

Managed care contracts are usually written to auto-renew on an annual basis so you will want to analyze your contracts annually. Use the end of the year to calculate your per-visit reimbursement for a given contract and compare it to per-visit reimbursements for your cash and out-of-network patients. Based on these figures, you can determine if the volume of patients seen from a particular payer offsets any variance in reimbursement. Then, negotiate accordingly.

Which Procedure Codes are Most Frequently Used by Acupuncturists?

In general, the most frequently used CPT procedure codes are those relating to medical evaluation and management, a few of which include:

  •    99201-05: New Patient Office Visit
  •    99211-15: Established Patient Office Visit
  •    99281-85: Emergency Department Visit
  •    99241-45: Office Consultation

Specifically for acupuncturists, the following are the most frequently used CPT codes:

  • 97810: Initial Acupuncture Session (Tip: do not report this in conjunction with 97813; use one or the other)
  • 97811: Subsequent Unit of Acupuncture (You may use it in conjunction with either 97810 or 97813)
  • 97813: Initial Acupuncture with Electrical Stimulation (Don’t report this in conjunction with 97810; use one or the other)
  • 97814: Subsequent Unit of Acupuncture with Electrical Stimulation (This may be used in conjunction with either 97810 or 97813)

Accurate medical billing codes are instrumental for streamlining your billing process and further growing your acupuncture practice.

Do You Have a List of Insurances That Will Pay for Acupuncture That I Can Use?

Unfortunately, we don’t have a perfect answer for this! Insurance benefits will vary from plan to plan - even within the same insurance company - so there’s no quick shortcut for knowing if the patient‘s insurance will cover acupuncture. It’s really a case-by-case basis when serving patients who might have Medicare, go through the VA, or hold a private insurance policy otherwise. HBS recommends that you verify the patient‘s benefits before you treat the patient by contacting the payer directly or confirming their insurance plan prior to each visit.

Do I Have to Implement Electronic Health Records (EHR) in My Practice?

No, although you will need to document each patient visit, there is no legal mandate to implement EHR for your acupuncture practice. The Centers for Medicare and Medicaid Services (CMS) rolled out Meaningful Use non-compliance penalties in 2015, but most acupuncture practices do not meet the minimum revenue standard for Medicare so these penalties should not apply to your practice.

Though not legally required, using electronic health records can greatly streamline your administrative tasks and help your acupuncture practice operate more efficiently.

Can I Bill Insurances for Massage Therapy?

Yes, there are insurance plans that will pay for massage therapy treatments performed by a licensed massage therapist or licensed acupuncturist! As always, be sure to verify the patient’s insurance benefits information and utilize accurate medical billing codes. The following are the most frequently used for massage therapy sessions:

  • 97124: Massage Therapy
  • 97140: Manual Therapy Massage Therapy
  • 97112: Neuromuscular Re-Education
  • 97010: Hot/Cold Packs
  • 97110: Therapeutic Exercise

Have More Questions About Acupuncture Billing? Reach Out to the Experts at HBS!

HBS is an acupuncture billing service that is experienced in billing for both licensed massage therapists and licensed acupuncturists. As an experienced billing provider for holistic practices, Holistic Billing Services can help your practice navigate the insurance billing process to minimize denials and increase revenue. 

With our team of experts by your side, you can focus more on treating patients to help your practice grow rather than worrying about insurance billing. To learn more about our acupuncture or massage therapy billing services, talk to one of our billing and coding experts today.

May 17, 2021
 - by Antonio Arias, MBA, CHBME

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