CPT Codes for Acupuncture

Information excerpted from the MAS seminar: A Pathway Through the CPT Code Jungle, held Saturday, May 14, 2005. Presented by Marsha Yurko, insurance coordinator for the Tai Sophia Clinic.


The New Acupuncture Codes - effective January 1, 200The New Acupuncture Codes - effective January 1, 2005

  • 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 reinsertion.
  • 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 reinsertion.
  • DO NOT MIX CODES on the same treatment for non-electrical stimulation acupuncture and electrical stimulation acupuncture. If electrical stimulation is used at all in a treatment, only the last two codes should be used.

Reinsertion

  • The word was added by the reimbursement update committee.
  • Simply means "additional" points are used.
  • Must be documented in notes.
  • Will insurance companies be looking for reinsertion? Most will not.
  • Why? Because TIME is the primary factor.

Applying the New Codes

  • New codes are based on amount of time spent with the client.
  • Not like the old codes - one code = one treatment.
  • new codes allow billing of 97810 and 97811 x1, x2, etc.

TIME Factor

  • TIME is the primary factor of new codes.
  • TIME means the amount of time spent face to face with the client.
  • The work group determined, among other things, new acupuncture codes based on TIME would reflect level of involvement of practitioner.
  • More involved cases = more time = additional costs