As an acupuncture billing company, we understand that translating Eastern medicine techniques into Western medicine procedure codes can seem daunting. Even the most experienced acupuncturists get their codes mixed up. But if you want to avoid insurance-company denials, you need to use proper coding. Here are some helpful tips.
When providers bill insurance for acupuncture, one of the most common mistakes we see is the improper use of multiple-unit codes or time-based codes. For example, a 60-minute acupuncture session with multiple reinsertions and with an infrared heat lamp requires the use of the following three codes:
| Description | Code |
| Initial acupuncture | 97810 |
| Acupuncture = 15 min | 97811 |
| Infrared | 97026 |
Most acupuncturists learn to use the procedure codes fairly quickly. The correct use of the corresponding units, however, makes the coding a bit more complex. In this 60-minute acupuncture session, the visit is broken down into four units at 15 minutes per unit. Code 97810 is used for the initial insertion of needles and covers the first 15 minutes of the visit. It is always reflected as one unit. In the example, code 97811 should be billed for three units to cover the remaining 45 minutes of face-to-face time with multiple reinsertions. Common usage of code 97811 is anywhere between one and five units. Finally, the use of an infrared heat lamp is always coded as one unit. Here is how the patient’s 60-minute visit is coded correctly:
| Description | Code | Units |
| Initial acupuncture | 97810 | 1 |
| Acupuncture = 15 min | 97811 | 3 |
| Infrared | 97026 | 1 |
There are many nuances to getting paid for acupuncture, but knowing which codes require multiple units should be one of your first steps to getting the coding right. Here is a helpful list of codes you are likely to use and when to apply multiple units for the procedures:
| Description | Code | Multi-Unit |
| New Patient Visits | 99201-99204 | No |
| Established Patient Visits | 99211-99214 | No |
| Initial Acupuncture | 97810 | No |
| Acupuncture = 15 mins | 97811 | Yes |
| Initial Acup/E stim | 97813 | No |
| Acup/ES +15 | 97814 | Yes |
| Electric Stim unattended | G0283 | No |
| Manual E/Stim attended | 97032 | Yes |
| Cupping | 97016 | No |
| Injection Single | 20550 | No |
| Manual Therapy | 97140 | Yes |
| Massage Therapy | 97124 | Yes |
| Neuro Muscular Ed | 97112 | No |
| Kinetic Activities | 97530 | Yes |
| Therapeutic Exercise | 97110 | Yes |
| Infrared | 97026 | No |
| Heat Therapy | 97010 | No |
| Injection, one/two sites | 20552 | No |
Are you interested in learning more about acupuncture billing?
Here are some additional tips!
And if you are interested in an acupuncture billing service...
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