Acupuncture Billing and Coding

Acupuncture billing and coding is among the key specialty billing that involve several complexities that result from constantly varying codes and wide variety of treatments that differ from clinic to clinic. Though pain-related acupuncture treatment is the most common form of treatment that acupuncturists undertake, there are other conditions that some of the Physicians treat, including chronic diseases, dental, mental health, asthma, etc.

With innumerable variations and complexities involved in the process, billing guidelines and regulatory compliance are not among the top priorities for the Practitioners. This blog aims to Simplify Healthcare Experiences for Acupuncture practitioners by breaking down the intricacies and the nuances of Acupuncture billing and how healthcare organizations can optimize their financial performance.

	Common CPT Codes You Don’t Want to Ignore!
CPT Code	Description
20560	Needle insertion(s) without injection(s), 1-2 muscles, describes the work of dry needling to 1 or 2 muscles
20561	3 or more muscles, describes the work of dry needling to 3 or more muscles
97014	Supervised electric stimulation, Application of a modality to one or more areas
97032	Attended manual electric stimulation, the requirement for constant attendance is derived from the manual-application requirement.
97810	Acupuncture, one or more needles, without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
97811	Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles
97813	Acupuncture, one or more needles, with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
97814	Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles
97032	Attended manual electric stimulation, the requirement for constant attendance is derived from the manual-application requirement.
HCPCS Code	Description
A4212	Noncoding needle or style
A4215	Needle, sterile
G0283	Electrical stimulation (unattended)
S8930	Electrical stimulation of auricular acupuncture points

In accordance with the code descriptions and/or the Centers for Medicare and Medicaid Services (CMS) guidelines and CMS Medicaid National Correct Coding Initiative (NCCI) established Medically Unlikely Edits (MUE) values, the maximum units of acupuncture services allowed per date of service are as below.

S.No	CPT Code	Medically Unlikely Edits (MUE) values
1	20560	1
2	20561	1
3	97810	1
4	97811	2
5	97813	1
6	97814	2
7	S8930	3

Acupuncture Billing Guidelines

Medically Necessary Acupuncture benefits are available for patients that meet the Centers for Medicare & Medicaid (CMS) criteria for Chronic Lower Back Pain. To determine qualification, a request for prior authorization must be submitted. Supplemental acupuncture benefits are available for patients enrolled in a participating plan. Generally, these services do not require prior authorization unless mandated by the health plan.

Acupuncture Treatments include

• a review of the patient’s chart,
• obtaining a brief account of the results of the previous treatment
• selecting points for the day’s treatment, and
• post service documentation and consultation.

How Physical Therapy Works

Physical therapists focus on self-care, exercise regimens and guided patient education materials that help them improve the overall quality of life. Physical therapy not just offers treatment for health concerns but offers preventive and prescriptive care that could prevent possible future health issues that may occur due to poor lifestyle and negligence of care. Here are the most common CPT codes that are applicable for Physical Therapists (PT).

CPT Code	Description
97110	Therapeutic Exercise
97140	Manual Therapy
97112	Neuromuscular Re-Education
97530	Therapeutic Activities
97010	Hot/Cold Packs
97014	Electrical Stimulation (Unattended)
G0283	Electrical Stimulation, Medicare Non-Wound (Unattended)
97035	Ultrasound/Phonophoresis
97161	PT Evaluation: Low Complexity
97162	PT Evaluation: Moderate Complexity
97116	Gait Training
97535	Self-Care/Home Management Training
97016	Vasopneumatic Device
92507	SLP Treatment; Individual
97032	Electrical Stimulation (Manual)
97164	PT Re-Evaluation
97012	Mechanical Traction
97150	Group Therapy
97113	Aquatic Therapy/Exercise
97124	Massage Therapy

Final Words

With innumerable complications involved in acupuncture therapies, Practitioners face major challenges with acupuncture billing and coding. At SolvEdge, we simplify healthcare financial experiences for our clients by staying on top of the constantly evolving regulations, state-wise rules, HIPPA guidelines and much more. Our certified and experienced team of coders and billing experts are dedicated to increasing Practice revenues, while preventing losses.

Our SMEs, technologists and strategists work together to save clients’ time, mitigate errors, reduce appeals and re-filing—thereby saving millions of dollars of lost revenues.

Get started with our No Cost Gap Analysis to evaluate your missed out payments and recoup your lost revenues with our medical billing experts. Give us a shout!