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Acupuncture CPT Codes

Medically necessary acupuncture treatments and benefits are for patients who meet CMS (Centers for Medicare and Medicaid) criteria – for lower back pain. To determine the patients’ qualifications, a prior authorization request is submitted. It is a part of acupuncture medical billing services. Additionally, the acupuncture CPT codes are treatment-specific – more on that later. Furthermore, supplemental acupuncture benefits are for patients enrolled in participating plans. Such do not need prior authorizations unless specific health plans direct it.

The Acupuncture Treatments Include:  

  • Thorough reviews of patients’ charts
  • Collecting and analyzing small accounts of the previous treatment results
  • Deciding on the points of treatment for the day
  • Documentation and consultation after the treatment

Acupuncture CPT Codes and Billing Guidelines

Understanding how to bill insurance providers for acupuncture services accurately is vital to running a successful practice. We have some standard acupuncture CPT codes below for your reference:

Insurance Codes for Acupuncture Medical Billing Services

Even when you outsource your medical billing services to third-party billing companies, knowing the correct CPT codes is vital. Every insurance provider can decide which codes they will reimburse, and that varies from provider to provider.

Ideally, there are 4 Acupuncture CPT codes. Furthermore, these codes are associated with 15-minute increments of time, so you get to use one for a specific code for the first 15 minutes, with an additional code for the other times and the set of needles. The first two codes will be used together for initial and subsequent needle insertion and time with a particular patient. CPT Codes for Acupuncture 97810-97814 are classified as time-based codes.

Different CPT Codes for Acupuncture:

  • 97810 – It is for acupuncture for one or more needles, without electrical stimulation, for an initial 15 minutes.
  • 97811 – The code is for acupuncture with one or more needles, without electrical simulation, and for each additional 15 minutes. With needle re-insertion.
  • 97813 – It is for one or more needles along with electrical stimulation for an initial 15 minutes
  • 97814 – The particular acupuncture code is for one or more needles in addition to electrical stimulation, for every additional 15 minutes, along with needle re-insertion.

Office Visits Acupuncture CPT Codes

Below are some of the CPT codes you will need for office visits:

Codes for New Patients

  • 99201 – Office visit code for management and evaluation of a new patient. It has three components: problem-focused history, problem-associated examination, and straightforward medical decision-making – here, the presenting problems are minor or self-limiting. One code is billed per visit for 10 minutes.
  • 99202 – This code is for managing and evaluating a new patient. It comes with three major components: an expanded problem-oriented history, a problem-focused examination, and straightforward decision-making. Here, the presenting problems range from love to moderate severity. It is billed for 20 minutes, and one code is for one visit.
  • 99203 – Again, one of the significant acupuncture CPT codes, it has three components: detailed history, detailed examination, and low complexity medical decision-making. The presenting problems here have moderate severity.
  • 99204 – Office visit for new patient evaluation and management of new patients. Once again, it is another of the vital CPT codes with three components, including comprehensive history, an examination, and medical decision-making of moderate complexity. The codes tackle presenting problems of medium to high severity.

 

Physical Therapy Acupuncture CPT Codes

  • 97010 – It is for heat therapy. Its application is a modality to one or more regions through hot or cold packs.
  • 97016 – Vasopneumatic devices are applied for treatments to one or more areas.
  • 97026 – It’s for infrared therapy; its application is for a modality of one or more regions.
  • 97110 – This is a therapeutic exercise for one or more areas every 15 minutes. The therapeutic procedures work to develop endurance and strength, in addition to a range of motion and flexibility with direct patient contact.
  • 97140 – For manual therapy techniques of one or more regions. Each for 15 minutes of manipulation/mobilization, manual lymphatic drainage, and manual traction.
  • 97530 – It is for kinetic activities, where dynamic activities improve functional performance. Each is for 15 minutes with direct contact with the patient.

Final Word

Learning the art of acupuncture CPT codes and medical billing services is vital for a successful practice. Accurate coding makes fair reimbursements easier for necessary treatment. Understanding the physical therapy and office visit codes makes patient care better. Stay informed with PRG, code accurately, and succeed in your acupuncture billing journey.

Frequently Asked Questions

The CPT code 97110 is a therapeutic procedure code. This code is used for exercises to develop strength, endurance, flexibility, and range of motion.

The following are common modifiers for changing a CPT code:

  • 25: Billers must modify an E&M code with the ‘-25’ to signify that it is a significant, separately identifiable service.
It is an acupuncture CPT code with one or more needles along with electrical stimulation for each additional 15 minutes of one-on-one contact with patients.

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