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CPT Codes and Their Importance for Acupuncturists

Acupuncture billing can be a complex and confusing process for us. It is important to understand specific Current Procedural Terminology (CPT) codes and guidelines to ensure accurate billing for acupuncture services. These codes and guidelines have been set forth by the American Medical Association (AMA). This article aims to provide you with some clarity on billing for acupuncture and prevent you from losing income from disputes or rejected claims.

First Thing’s First- New Patient Visits

Acupuncture office visits, also known as Evaluation and Management (EM) have specific billing guidelines. Providers can bill for EM services using CPT codes 99201 – 99204 for a new patient visit. After that, any

E/M services can be billed for periodic follow-up evaluations (every 30 days or every sixth visit using CPT codes 99211 – 99214) with established acupuncture patients.

American Acupuncture Council Network. “Billing & Coding: Acupuncture Office Visits.” AAC Info Network, American Acupuncture Council Network, 29 July 2021, www.aacinfonetwork.com/billing-coding-acupuncture-office-visits/. Accessed 2023.

For all other visits with your existing patients, you’ll select from the codes 97810-97814, which have EM included already. Let’s discuss these four standard codes next.

Acupuncture CPT Codes:

Acupuncture procedures are classified under four CPT codes, each representing a different type of acupuncture treatment. Since the acupuncture treatment itself is always billed in 15-minute increments, you will use one CPT code for the first 15 minutes of service and another, separate CPT code for the additional units of time thereafter. Let’s take a look at these codes and their definitions provided by Holistic Billing Services, now:

  1. 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.)
  2. 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)
  3. 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.)
  4. 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)
Arias, Antonio. “2022 Acupuncture CPT Codes for Insurance Billing.” Holistic Billing Services, 3 Feb. 2023, holisticbillingservices.com/2022-acupuncture-cpt-codes-for-insurance-billing/.

Understanding the Time Component:

When looking at these codes, it is important to mention that the focus should not just be on the 15-minute time increments. Believe it or not, the main qualifier to use codes an additional code for acupuncture (97811 or 97814) lies in the requirement of the re-insertion of needle(s). This might even surprise a few seasoned providers! This is what Sam Collins, coding and billing expert for the American Acupuncture Council, had to say regarding this unique stipulation:

cpt time

Due to confusion and multiple interpretations when the codes first were introduced in 2005 the AMA CPT Assistant made further clarification in the June 2005/Volume 15, Issue 6, “re-insertion of the needle(s) is required for the use of add-on codes 97811 and 97814. This means of course that simply having a patient retain a single set of needles for more than 15 minutes would not constitute the ability to bill an add on code such as 97811 or 97814.

Collins, Samuel . “Billing and Time Matters | Acupuncture Today.” Acupuncturetoday.com, Acupuncture Today, Nov. 2012, acupuncturetoday.com/article/32653-billing-and-time-matters. Accessed 2023.

This means that simply having a patient retain a single set of needles for more than 15 minutes does not qualify for billing an add-on code such as 97811 or 97814. There must be reinsertion of needles. Of course, no one is saying break from CNT and reinsert the same needles, either, so it literally is coding for a back-to-back treatment of sorts. Interesting. Let me know in the comments below what you all think. 🤯

Let’s Define “Personal One-on-One Contact Time”:

The 15-minute increment in the acupuncture codes represents the time spent in “personal one-on-one contact with the patient”. During this time, the acupuncturist must perform activities related to the acupuncture needling. This includes prep work like point selection, locating, cleaning, etc. It also includes the time to insert, manipulate, and remove the needles.

The duration needles are retained is separate from one-on-one time, not influencing billing or reimbursement. However, the visit duration encompasses greeting, intake, charting post-treatment, and patient instruction.

Billing for Acupuncture with Retained Needles:

The provider may bill only one unit of acupuncture (97810 or 97811) when inserting and retaining a set of needles for 30 minutes, as per the aforementioned guidelines. There is no actual need for ongoing contact as the needles are retained. The time spent on needle retention, therefore, does not warrant additional billing.

Acupuncture v. Physical Medicine Services:

Acupuncture coding (97810, 97811, 97813, and 97814) is distinct from physical medicine coding (97001-97755). Acupuncture and physical medicine coding both use “15-minute increments,” but each has separate sections in the CPT. To learn about active therapy and modality codes for acupuncturists, check out my article CPT Codes: Charting is Everything.

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