Question: One of our pain management physicians is beginning to offer acupuncture services. Do carriers reimburse for the service? If so, what codes should I submit for the encounter?
North Carolina Subscriber
Answer: CPT includes four codes for acupuncture:
• 97810 -- Acupuncture, one or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
• +97811 -- ... without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (list separately in addition to code for primary procedure)
• 97813 -- ... with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
• +97814 -- ... with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (list separately in addition to code for primary procedure).
Medicare continues to have a national policy of noncoverage for acupuncture. Some other payers, however, have begun allowing coverage for some alternative medical treatments, including acupuncture.
Heads up: Many carriers that do reimburse for acupuncture treatments frequently have limitations regarding the number of sessions allowed and/or the conditions that support medical necessity for the treatment. Some carriers, for example, do not reimburse acupuncture to treat fibromyalgia, chronic pain or other pain-related conditions.
Because of this stance, check with your payer representatives to verify their policies. Your physician might opt to offer the service, but on a cash basis.
Time matters: Because acupuncture codes are time-time-based, documentation should include the amount of time your provider spent in personal (face-to-face) contact with the patient -- even though this might not necessarily be the same amount of time as the duration of acupuncture needle placement.
