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The Top Reason You’re Not Getting Paid for Acupuncture

top reason you're not getting paid

There are numerous errors that can cause your insurance claims to be denied or delayed, resulting in your holistic practice not being paid on time for your services. A successful acupuncture practice is one with accurate acupuncture insurance billing, but how can you stay on top of it?

As an acupuncture billing company, our team at Holistic Billing understands that translating Eastern medicine techniques into Western medicine CPT codes can seem daunting. Even the most experienced acupuncturists get their procedure coding mixed up. But if you want to avoid insurance company denials, you need to use proper acupuncture CPT codes. Here are some helpful tips to avoid claim delays and denials so your practice can be paid for your acupuncture treatments. 

How Providers Bill Insurance for Acupuncture

Current Procedure Terminology, or CPT codes, are used by insurance providers to document most medical procedures performed by healthcare providers, whether traditional or holistic.

These CPT codes characterize the type of procedure being done so healthcare providers can bill insurance companies for the right services and receive reimbursements. 

Although holistic practices also use CPT codes to receive payments from insurance providers, they have their own unique codes and requirements which can make the process prone to errors. Understanding when to use the right acupuncture insurance billing codes is crucial to ensure a streamlined reimbursement process and receive timely payments for acupuncture treatments. 

When mistakes are made during the billing process, whether due to inaccurate patient information or coding, the insurance company can deny the claim. This can delay the amount of time your holistic practice is paid by weeks – if not longer. 

Common Mistakes in Acupuncture Billing That Can Prevent You From Getting Paid

Even simple errors during the acupuncture billing process can result in delays and denials that can prevent your practice from receiving payments. Avoid some of these more common mistakes in billing for your acupuncture treatments for efficient and reliable reimbursements.

Inaccurate Acupuncture CPT Codes

Errors with acupuncture billing codes – whether minor or major – can cause your acupuncture practice to not get paid. It’s key to follow the specific guidelines for acupuncture billing to prevent common denials, which can cause more problems for your practice than delayed payments. 

Too many denied claims can land your acupuncture practice in hot water with compliance issues. Stage and federal regulators can perform an audit on your insurance billing if there are too many undercoding and overcoding denials. 

Your acupuncture practice should aim for a clean claim rate above 95%. The higher your clean claim rate, the less time and energy your acupuncture practice will spend on fixing denied claims and re-submitting them – and the quicker you’ll receive your payments.

Improper Use of Multiple-Unit Codes

One of the most common mistakes is the inaccurate use of multiple-unit codes or time-based codes. For example, a 60-minute acupuncture session with multiple reinsertions and with an infrared heat lamp requires the use of the following three codes:

  • 97810 Initial Acupuncture
  • 97811 Subsequent Unit of Acupuncture Per Additional 15 Minutes
  • 97026 Infrared Acupuncture

The correct use of the corresponding units makes the coding a bit more complex. In this 60-minute acupuncture session, the visit is broken down into four units at 15 minutes per unit. Code 97810 is used for the initial insertion of needles and covers the first 15 minutes of the visit. It is always reflected as one unit. 

In the example, code 97811 should be billed for three units to cover the remaining 45 minutes of face-to-face time with multiple reinsertions. Common usage of code 97811 is anywhere between one and five units. Finally, the use of acupuncture heat lamps (infrared acupuncture) is always coded as one unit. Here is how the patient‘s 60-minute visit is coded correctly:

  • 1 Unit 97810 Initial Acupuncture
  • 3 Units 97811 Subsequent Unit of Acupuncture Per Additional 15 Minutes
  • 1 Unit 97026 Infrared Acupuncture

Ineligible Insurance Coverage

While many billing problems with insurance companies are the result of inaccurate CPT codes, there are times payments are delayed and denied due to ineligible insurance coverage of established patients. This occurs when established patients update their insurance but healthcare providers do not. This can be due to patients not alerting their healthcare provider or the provider failing to update patient records. 

This disruption can be avoided by regularly checking your established patient’s insurance liability at every visit. Keeping up-to-date patient records can also prevent insurance issues from disorganization. 

Most Used Acupuncture CPT Codes & When To Apply Multiple Units

Most Used Acupuncture CPT Codes & When To Apply Multiple Units

Most Commonly Used Acupuncture CPT Codes

These commonly used 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. 

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. If you include electronic stimulation in your treatment, then your billing codes will vary. 

97810 Initial Acupuncture

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.)

97811 Subsequent Unit of Acupuncture

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.)

97813 Initial Acupuncture with Electrical Stimulation

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.)

97814 Subsequent Unit of Acupuncture with Electrical Stimulation

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.)

When to Apply Multiple Units?

There are many nuances to getting paid for acupuncture, but knowing which CPT codes require multiple units should be one of your first steps to getting the coding right. Here is a helpful list of codes you are likely to use and when to apply multiple units for the procedures:

Description Code Multi-Unit?

New Patient Visits 99201-99204 No

Established Patient Visits 99211-99214 No

Initial Acupuncture 97810 No

Acupuncture = 15 mins 97811 Yes

Initial Acup/E stimulation 97813 No

Acup/ES + 15 97814 Yes

Electronic Stim unattended G0283 No

Manual E/Stim attended 97032 Yes

Cupping 97016 No

Injection Single 20550 No

Manual Therapy 97140 Yes

Massage Therapy 97124 Yes

NeuroMuscular Ed 97112 No

Kinetic Activities 97530 Yes

Therapeutic Exercise 97110 Yes

Infrared Acupuncture 97026 No

Heat Therapy 97010 No

Injection, one/two sites 20552 No

Experience More Accurate Medical Billing and Boost Revenue in Your Holistic Practice With HBS

Accurate acupuncture billing is the key to receiving payments for your acupuncture treatments on time. Although billing the right acupuncture CPT codes can be a lengthy process, it’s necessary to avoid delays and denials that will hurt your practice’s revenue cycle management. 

No 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 can be invaluable for an efficient acupuncture billing experience. 

The team at Holistic Billing Services understands the unique needs of acupuncture practices and has the experience with acupuncture CPT codes you can trust to provide the most accurate and quality billing services you need to start delivering the acupuncture treatments to your patients – and receive your reimbursements. 
To learn more about how Holistic Billing can help streamline your practice and accelerate your revenue cycle management, contact our team today.

December 20, 2023
 - by Antonio Arias, MBA, CHBME
top reason you're not getting paid

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