Wiki Medicare Reimbursement for 20560 and 20561...Any advice??

[kpina613]

CMS says they pay for TDN 20560 and 20561 however, I am struggling to get it reimbursed. I was told that billing it with a GP modifier was the reason it was denying. It is a physical therapist performing the dry needling. I didn't see anything on CMS that states a physical therapist couldn't be reimbursed but it could be that. Any advice on this would be wonderful! Thanks in advance!

 

[CBLENNIE]

Dry needling falls under the acupuncture benefit category and there are limitations on what conditions Medicare covers acupuncture for and who may perform it and I don't believe Medicare covers it when performed by a physical therapist. Check out NCD 30.3.3 Acupuncture for Chronic Lower Back Pain (cLBP) along with transmittal # 10337 SUBJECT: National Coverage Determination (NCD30.3.3): Acupuncture for Chronic Low Back Pain (cLBP).