Most Used CPT Codes For Acupuncturists

Knowing how to bill insurance is an integral part of running a successful acupuncture clinic. Listed here are some of the most used insurance billing CPT codes used within the scope of a professional acupuncturist.

Insurance Billing Codes for Acupuncture

Complied here is a list of some of the most used acupuncture CPT codes. Even if you are hiring out your billing services, it is still important to know the correct CPT codes. Each insurance company gets to decide which codes they will reimburse and that will change between insurance companies.

There are four main acupuncture billing codes. These codes are associated with 15 minute increments of time, so you will use one specific code for the initial 15 minutes, and then an additional code for the additional time and set of needles.

The first two codes can be used together for initial and subsequent needle insertion and time with a patient, as can the last two, but these two sets of codes are not to be used together. ( Even if you only do electro-acupuncture for the initial 15 minutes with one set of needles, and then insert another set of needles without electro-acupuncture- you must use both electro acupuncture codes.)

Codes 97810-97814 are are time-based codes..

• 97810: Acupuncture, one or more needles, without electrical stimulation, initial 15 minutes
• 97811: Acupuncture, one or more needles, without electrical stimulation, each additional 15 minutes. With needle re-insertion.
• 97813: Acupuncture, one or more needles, with electrical stimulation, initial 15 minutes
• 97814: Acupuncture, one or more needles, with electrical stimulation, each additional 15 minutes. With needle re-insertion.

Office Visit Billing Codes

Here are the CPT codes you’ll need for office visits.

New Patients

Acupuncturists most often are reimbursed for the billing of E&M codes (evaluation and management), or otherwise known as office visit codes. The three main aspects of being able to bill these codes is the documentation of medical history, examination and, medical decision-making.

• 99201: Office visit for the evaluation and management of a new patient, with 3 main components: a problem focused history; a problem focused examination; and straightforward medical decision making, in which presenting problems are self-limited or minor. 10 minutes. One code billed per visit.
• 99202: Office visit for the evaluation and management of a new patient, with 3 main components: an expanded problem focused history; an expanded problem focused examination; and straightforward medical decision making, presenting problems are of low-moderate severity. 20 minutes. One code billed per visit.
• 99203: Office visit for the evaluation and management of a new patient, with 3 main components: a detailed history; a detailed examination; and medical decision making of low complexity, presenting problems are of moderate severity. 30 minutes. One code billed per visit.
• 99204: Office visit for the evaluation and management of a new patient, with 3 main components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity, presenting problems are of moderate to high severity. 45 minutes. One code billed per visit.

Established Patients (Re-evaluation)

Acupuncturists most often are reimbursed for the billing of E&M codes for return or established patients, otherwise known as re-evaluation codes. These codes are not to be used every subsequent visit as the Acupuncture codes above include time for regular evaluation and management to check patient progress. A good rule of thumb is to bill this around every 6 visits, or about 6 weeks, or if there is a notable change in chief complaint.

• 99212: Office visit for the evaluation and management of an established patient, with a problem focused history; a problem focused examination; straightforward medical decision making, presenting problems are self-limited or minor. 10 minutes. One code billed per visit.
• 99213: Office visit for the evaluation and management of an established patient, an expanded problem focused history; an expanded problem focused examination, medical decision making of low-complexity, presenting problems are low-moderate severity. 15 minutes. One code billed per visit.
• 99214: Office visit for the evaluation and management of an established patient, detailed problem focused history; a detailed problem focused examination; moderate medical decision making, and presenting problem(s) are moderate-high severity. 25 minutes. One code billed per visit.

Physical Therapy Billing Codes

A list of common physical therapy billing codes…

• 97010: Heat Therapy. Application of a modality to one or more regions; hot or cold packs.
• 97016: Cupping. Vasopneumatic device is applied during treatments to one or more areas.
• 97026: Infrared Therapy. Application of a modality to one or more regions
• 97110: Therapeutic Exercise. One or more regions, each 15 minutes; therapeutic procedures to develop strength and endurance, range of motion, and flexibility with direct patient contact.
• 97140: Manual Therapy. Manual therapy techniques, one or more regions, each 15 minutes (mobilization/manipulation, manual lymphatic drainage, manual traction.
• 97530: Kinetics Activities. Use of dynamic activities to improve functional performance, each 15 minutes with direct patient contact.

CPT Code Modifiers

And these are common modifiers used to change a CPT.

• -25: you must modify an E&M code with the “-25” modifier to signify that this is a significant, separately identifiable level of service.
• -59: you must modify using “-59” to identify procedures and services that are not normally reported together, but are appropriate under the circumstances. Not to be used on E&M codes.