The world of insurance billing is complex, and even more so for holistic practices. Understanding when to use the right acupuncture billing codes and procedures is essential to any successful medical practice - whether holistic or traditional. Accurate coding and billing practices ensure a streamlined reimbursement process so your practice can get paid and deliver the best care to your patients.
As a billing company focused on holistic healthcare providers, Holistic Billing is an expert in the world of acupuncture billing CPT codes. In any given year, roughly half of our new clients have never billed insurance before they started with Holistic Billing Services, so we are quite accustomed to their most frequently asked questions. Find the answers to many of the most common questions about Acupuncture CPT codes and billing practices below!
Current Procedure Terminology, or CPT codes, are used to document the majority of medical procedures performed by health care providers. These medical billing codes characterize the type of procedure being done so providers can properly bill insurance companies and receive reimbursements for administered services.
Acupuncture practices use codes that correspond to their unique services. Since services are usually coded in 15-minute increments, you will use one code for the initial 15 minutes of service and then a separate code for additional units of time. Acupuncture CPT codes will only vary if you include electronic stimulation in your treatment.
Ensuring accurate billing practices is essential for any medical practice - whether traditional or holistic - to receive efficient reimbursement for services. Besides allowing insurance companies to deliver accurate payments for healthcare providers, accuracy with billing codes also creates a valid record of patient care history.
When it comes to holistic practices, ensuring accurate billing and coding is an important indicator of a practice’s financial health since mistakes can result in costly fines and reimbursement delays. Some estimates find inaccurate coding and billing can result in errors on up to 80% of medical bills - resulting in weeks of editing and resubmissions that delay reimbursement and waste time for your staff.
Properly filling out claims with the right acupuncture CPT codes can provide an efficient billing and coding process for your holistic practice and make it possible to avoid many of the negative impacts that can result from consistent coding and billing errors. If your holistic practice continues to make mistakes with acupuncture codes, you can have increased denial rates and declining insurance reimbursements, which could put your practice at risk. Accurate acupuncture CPT codes and billing practices can help ensure your holistic practice reaches its full revenue potential.
Many acupuncture practices may be looking for a comprehensive list of acupuncture billing CPT codes to have handy. Below is a summary of procedure codes that we feel most insurances will reimburse.
The acupuncture CPT codes are broken down by the three main sources of revenue for your practice: acupuncture treatments, office visits, and physical therapy-based treatments and modalities. We encourage you to keep the list handy and please keep in mind that your patient’s insurance coverage is determined by the plan and the employer; it is not enough to just know the insurance company’s name.
When you plan to bill insurance for acupuncture, we always recommend that you verify your patient’s insurance benefits directly with the payer before you start treatments. Also, remember that Medicare has special rules pertaining to acupuncture practices. No matter who your practice is billing, it’s important to keep accurate documentation to verify which acupuncture treatments were administered and why.
The bulk of the services you will bill to insurance will likely fall under four essential acupuncture CPT codes. Since acupuncture services are always billed in 15-minute increments, your practice will use one code for the initial 15 minutes of service and then a separate code for additional units of time. Your acupuncture billing codes will only vary if you include electronic stimulation in your treatment.
Initial 15-minute insertion of needles, personal one-on-one contact with the patient. (Do not report in conjunction with 97813; use one or the other.)
Use one unit per each additional 15 minutes of personal one-on-one contact with the patient after the initial 15 minutes, with re-insertion of needles. (May be used in conjunction with either 97810 or 97813.)
Initial 15-minute insertion of needles, personal one-on-one contact with the patient. (Do not report in conjunction with 97810; use one or the other.)
Use one unit per each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles. (May be used in conjunction with either 97810 or 97813.)
On January 21st, 2020, the Centers for Medicare and Medicaid Services (CMS) announced their decision to cover acupuncture for chronic low back pain. This is defined as localized pain in the lower back that persists for more than three months. While this decision marked the first time acupuncture services could be reimbursed by Medicare, there are additional requirements to follow for acupuncture services to qualify.
The current rules cover the following acupuncture billing codes for Medicare (at the current Medicare national average fee schedule). Keep in mind these should be treated as national averages as the actual fees will be based on where the services are rendered. You can look up specific codes based on your location here.
Acupuncture, one or more needles, without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient.
Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles.
Acupuncture, one or more needles, with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient.
Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles.
Services with needle insertion(s) without injection(s) of 1 or 2 muscle(s).
Services with needle insertion(s) without injection(s) of 3 or more muscle(s).
Office visits, otherwise known as evaluation and management services, may be billed on the initial patient evaluation and periodic follow-up evaluations. A good rule of thumb is every 30 days or every sixth visit. It is not appropriate to bill these codes every time the patient receives acupuncture treatments, as acupuncture CPT codes 97810, 97813, 97811, and 97814 all include evaluation and management done as part of the overall daily treatment.
Billing a new patient visit code the first time you see a patient using codes 99201 to 99204 is appropriate. A new patient is defined as someone who has not received professional services from you or another provider of the same specialty who has belonged to your practice within the past three years.
An established patient is defined as one who has received any professional services from you or another provider of the same specialty who has belonged to your practice within the past three years. Again, it is inappropriate to bill an established patient visit (codes 99211 - 99214) on every visit, as your usual acupuncture treatment codes already have a day-to-day evaluation component to assess the progress of your patient.
Use these acupuncture CPT codes for when your holistic practice receives new patients. As a reminder, a new patient is defined as a patient who hasn’t received professional services from you or another provider of the same specialty who has belonged to your practice within the past three years.
Presenting problems are self-limited or minor: requires a problem-focused history, problem-focused examination, and straightforward medical decision-making. The provider typically spends 10 minutes face-to-face with the patient.
Presenting problems are of low to moderate severity; requires an expanded problem-focused history, an expanded problem-focused examination, and straightforward medical decision-making. The provider typically spends 20 minutes face-to-face with the patient.
Presenting problems are of moderate severity; requires a detailed history, a detailed examination, and medical decision-making of low complexity. The provider typically spends 30 minutes face-to-face with the patient.
Presenting problems are of moderate to high severity; requires a comprehensive history, a comprehensive examination, and medical decision-making of moderate complexity. The provider typically spends 45 minutes face-to-face with the patient.
These CPT codes for acupuncture can be used for your established patients. Returning patients are those who have received any professional services from you or another provider of the same specialty who has belonged to your practice within the past three years
Presenting problems are minimal. The provider typically spends five minutes face-to-face with the patient.
Presenting problems are self-limited or minor; requires a problem-focused history, a problem-focused examination, and straightforward decision-making. The provider typically spends 10 minutes face-to-face with the patient.
Presenting problems are of low to moderate severity; requires an expanded problem-focused history, expanded problem-focused examination, and medical decision-making of low complexity. The provider typically spends 15 minutes face-to-face with the patient.
Presenting problem(s) are of moderate to high severity; requires a detailed history, a detailed examination, and medical decision-making of moderate complexity. Providers typically spend 25 minutes face-to-face with the patient.
Acupuncture practices use a variety of treatments and modalities to help their patients. These treatments and modalities help strengthen, relax, and heal muscles. Below are a few commonly-used acupuncture CPT codes your practice may encounter.
Single tendon injection for the treatment of fasciitis. Could include multiple injections into a single tendon sheath (CPT code 20550) or the tendon origin (CPT code 20551).
Injections involving single or multiple trigger points. Could be used to treat one or two muscles (CPT code 20552) or three or more muscles (CPT code 20553).
Application of a modality to one or more areas; hot or cold packs.
The use of a vasopneumatic device may be considered reasonable and necessary for the application of pressure to an extremity for the purpose of reducing edema.
The application of infrared therapy is considered medically necessary for patients requiring the application of superficial heat in conjunction with other procedures or modalities to reduce or decrease pain/produce analgesia or reduce stiffness/tension, myalgia, spasm, or swelling.
One or more areas, each 15 minutes; therapeutic procedures to develop strength and endurance, range of motion, and flexibility with direct (one-on-one) patient contact.
Treatments to restore movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities with direct (one-on-one) patient contact.
Techniques such as mobilization and manipulation, manual lymphatic drainage, and manual traction, one or more regions, each 15 minutes with direct (one-on-one) patient contact.
Includes effleurage, petrissage, and/or tapotement (stroking, compression, percussion) with direct (one-on-one) patient contact.
Use of dynamic activities to improve functional performance, each 15 minutes with direct (one-on-one) patient contact.
Documenting and billing the right acupuncture codes for insurance reimbursement can be a time-consuming process. No acupuncture practice wants to spend more time billing and coding than it does treating patients and expanding its list of clients. That’s where an experienced medical billing company with acupuncture CPT codes experience can be an invaluable partner.
The team at Holistic Billing Services understands the unique needs of acupuncture practices and has extensive experience working with acupuncture codes to ensure that you’re billing patients and insurance companies correctly. With our help, you can start seeing patients covered by insurance quickly and painlessly, no matter what type of acupuncture services you offer.
To learn more about how Holistic Billing can help streamline your practice and accelerate your revenue cycle management, contact our team today.
At Holbie, we offer complete and innovative Holistic Billing Services for acupuncture, massage therapy, and chiropractic providers.
At Holbie, we offer complete and innovative Holistic Billing Services for acupuncture, massage therapy, and chiropractic providers.
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