Both medical billing and coding are essential for medical and holistic practices seeking reimbursement for services. Acupuncture billing and coding is one of the most challenging areas of specialty billing due to continually changing codes and an extensive range of treatments that vary from clinic to clinic. Understanding when to apply the appropriate acupuncture CPT codes and processes is critical for the success of any medical business, whether holistic or traditional. Accurate acupuncture billing and coding methods enable a smooth payment process, allowing your clinic to be reimbursed while providing the finest care to your patients.
What Are Acupuncture CPT Codes?
Acupuncture billing processes differ from typical medical billing and have unique criteria. Acupuncture billing uses its own set of codes. Acupuncture treatments are coded in 15-minute increments; therefore, one code is used for the first 15 minutes of service, and a different code is used for successive units of time. Acupuncture CPT codes only differ if electronic stimulation is used as part of the therapy.
Why Is It Essential To Use The Correct Acupuncture Billing Codes?
Ensuring accurate billing and coding is a significant characteristic of the practice’s financial health because errors can result in substantial fines and payment delays. According to some calculations, incorrect acupuncture billing and coding can cause errors on up to 80% of medical bills, leading to weeks of editing and resubmissions that delay reimbursement and take a long for your team.
If your practice continues to commit acupuncture code errors, you may face higher denial rates and lower insurance payments, putting your practice at risk. Acupuncture CPT codes and accurate billing methods can assist your practice in attaining its full financial potential. Filling out claims correctly with the appropriate acupuncture CPT codes will create an effective billing and coding procedure for your holistic clinic, allowing you to prevent many adverse consequences caused by persistent coding and billing errors.
Most Common Procedure Codes Used By Acupuncturists
In general, the most commonly used acupuncture CPT procedure codes are those related to medical evaluation and management, such as:
99201-05: New Patient Office Visit
99211-15: Established Patient Office Visit
99281-85: Emergency Department Visit
99241-45: Office Consultation
The following are the most commonly used CPT codes for acupuncturists:
- 97810
- 97811
- 97813
- 97814
Accurate medical billing codes are critical for optimizing your billing process and expanding your acupuncture practice.
Four Important Acupuncture CPT Codes
The majority of the services will fall under four essential acupuncture CPT codes. If you include electrical stimulation in your session, your acupuncture billing codes will differ.
97810 Initial Acupuncture
This CPT code is used in case of initial 15-minute needle insertion, and one-on-one contact with the patient.
97811 Acupuncture Subsequent Unit
This kind of CPT code is used to cover the situation after the initial 15 minutes, use one unit for every additional 15 minutes of personal one-on-one interaction with the patient, including needle re-insertion.
97813 Initial Acupuncture with Electrical Stimulation
This code also covers initial 15-minute needle insertion and one-on-one contact with the patient.
97814 Acupuncture Subsequent Unit with Electrical Stimulation
Use one unit for every additional 15 minutes of one-on-one contact with the patient, including needle re-insertion.
Acupuncture CPT Codes for New Patients
When your practice gets new patients, use these acupuncture CPT codes.
99201 Evaluation/Management (Limited)
When the present difficulties are self-limited or minimal, a problem-focused history, problem-focused assessment, and simple medical decision-making are required. The provider usually spends 10 minutes with the patient face-to-face.
99202 Evaluation/ Management(Expanded)
The present difficulties are of low to moderate complexity; they necessitate a comprehensive problem-focused history, a comprehensive problem-focused examination, and straightforward medical decision-making. The provider typically spends 20 minutes with the patient face-to-face.
99203 Evaluation/ Management (Detailed)
The existing difficulties are of moderate severity; they necessitate a detailed history, detailed examination, and low-complexity medical decision-making. The provider usually spends 30 minutes with the patient face-to-face.
99204 Evaluation/Management (Comprehensive)
The present difficulties are of moderate to high severity; they necessitate a thorough history, a thorough examination, and medical decision-making of moderate complexity. The provider typically spends 45 minutes with the patient face-to-face.
Acupuncture CPT Codes for Returning Patients
These acupuncture CPT codes can be utilized for existing patients. Returning patients have obtained professional services from you or another practitioner of the same specialty connected with your practice in the last three years.
99211 Evaluation/Management (Minimal)
Presenting concerns are minimal; the provider usually spends five minutes face-to-face with the patient.
99212 Evaluation/Management (Limited)
Presenting concerns are self-limited or minimal; involves a problem-focused history, a problem-focused examination, and straightforward decision-making; the practitioner typically spends 10 minutes face-to-face with the patient.
99213 Evaluation/Management (Expanded)
Presenting difficulties are of low to moderate severity; needs an extending problem-focused history, expanded problem-focused examination, and medical decision-making of medium complexity; the provider typically spends 15 minutes face-to-face with the patient.
99214 Evaluation/Management (Detailed)
The existing problem(s) are of moderate to high severity; involves a detailed history, a detailed examination, and medical decision-making of moderate complexity; physicians usually spend 25 minutes face-to-face with the patient.
Acupuncture CPT Codes for Physical Therapy
Acupuncture practices offer their patients several treatments and approaches. These treatments and methods aid in the strengthening, relaxing, and healing of muscles. The following are some acupuncture CPT codes that your practice may encounter.
20550 & 20551 Tendon Injection
Fasciitis is treated with a single tendon injection. Multiple injections into a single tendon sheath (CPT code 20550) or the tendon origin are possible (CPT code 20551).
20552 & 20553 Muscle (s) Injection
Injections with a single or several trigger sites. It could be used to treat one or two muscles (CPT code 20552) or three or more muscles (CPT code 20553). (CPT code 20553).
97010 Heat Therapy
Application of a modality to one or more places, hot or cold packs.
97016 Cupping
A vasopneumatic device to apply pressure to an extremity to reduce edema may be considered acceptable and essential.
97026 Infrared Treatment
Infrared therapy is regarded as medically required for patients who require the use of superficial heat in combination with other medicines or modalities to lessen or decrease pain/produce analgesia, stiffness/tension, myalgia, spasm, or edema.
97110 Therapeutic Exercise
Every 15 minutes, one or more areas undergo therapeutic procedures to build strength and endurance, range of motion, and mobility with direct (one-on-one) patient contact.
97112 Neuromuscular Reeducation
Treatments that use direct (one-on-one) contact with patients to restore mobility, balance, coordination, kinesthetic sense, posture, and proprioception for sitting and standing tasks.
97140 Manual Therapy
Methodologies such as mobilization and manipulation, manual lymphatic drainage, and manual traction are applied to one or more areas every 15 minutes with direct (one-on-one) patient contact.
97124 Massage Therapy
Effleurage and tapotement (stroking, compression, percussion) with direct (one-on-one) patient contact are all part of massage therapy.
97530 Kinetic Activities
Every 15 minutes, use dynamic activities to enhance functional performance with close (one-on-one) patient contact.
HCPCS Code and Their Description
A4212: Noncoding needle or style
A4215: Needle, sterile
G0283: Electrical stimulation (unattended)
S8930: Electrical stimulation of auricular acupuncture points
Maximum Units Of Acupuncture CPT Code Services
Following the code descriptions, the CMS guidelines, and CMS Medicaid National Correct Coding Initiative (NCCI) established Medically Unlikely Edits (MUE) values, the maximum units of acupuncture services allowed per service date are below.
CPT Code | Medically Unlikely Edits (MUE) Values |
| 20560 | 1 |
| 20561 | 1 |
| 97810 | 1 |
| 97811 | 2 |
| 97813 | 1 |
| 97814 | 2 |
| S8930 | 3 |
Due to the numerous complexity involved in acupuncture therapy, practitioners face significant difficulties with acupuncture billing and coding. Documenting and billing the correct acupuncture codes for insurance reimbursement can take time. No acupuncture practice prefers to spend more time billing and coding than treating patients and building their practice. An experienced medical billing company with acupuncture CPT code experience can be a beneficial partner. Our simple, low-cost, and secure solutions help you expedite revenue cycle management and give the assistance you need to establish your practice. We have decades of expertise providing acupuncturists with excellent billing services. We optimize each claim to guarantee that you obtain the most insurance reimbursement possible as soon as feasible. Our certified coders specializing in acupuncture CPT codes help troubleshoot and advocate on your behalf with insurance companies regarding any billing and coding difficulties relating to your acupuncture services claim.
