With over 15 years of experience as an acupuncture insurance billing service we believe in educating the acupuncture community in acupuncture billing best practices. In this article we provide answers to the top five most frequently asked questions.
Do I need to be an in-network provider with an insurance plan in order to bill for my services?
No you do not. If you are a state licensed acupuncture provider, you are able to bill insurance plans for your services. Many insurance plans have benefits whether you are in or out of network. Knowing which plans will and will not reimburse, based on provider enrollment status, is the key to success in billing insurance for acupuncture services.
Can I bill for both an “office visit” and an acupuncture code for each of my sessions?
No, acupuncturists are not able to bill an evaluation and management (E/M) service code 99211-99215 for each acupuncture visit. The acupuncture codes 97810, 97811, 97813, and 97814 include the pre, intra and post service evaluation and management for the factors of history, evaluation, management and chart documentation as part of the overall treatment.
Initial patient visits requiring a history, examination, and diagnosis are billed using E/M codes 99201-99205. Follow-up visits that require a thorough re-examination and re-assessment resulting in significant findings or changes, are billed using E/M codes 99211-99215. Use modifier -25 when treatment is provided on the same date.
Sometimes I do both manual and electro acupuncture in the same visit. Am I able to bill for both of these initial services (97810 & 97813) on the same visit?
No, you are not able to bill for both of these initial services together. Both of these codes are for an initial set of needles and you are only allowed to bill one initial service per visit. Any set of needles used after the initial set is billed as a subsequent set. Use one of the subsequent billing codes of 97811 & 97814.
Do I need to bill for the needles as a separate line item to the acupuncture services?
No, you will not need to bill needles as a separate line item since they are inclusive of the acupuncture service.
When I am billing for acupuncture visits is there a maximum number of units I can bill?
No, there is no maximum threshold on billing units for acupuncture visits. You will bill for the number of units necessary to treat the patient’s condition. However, the number of units must be deemed reasonable and necessary to avoid triggering red flags for auditors. Billing for 2-3 units is common and anything above 4 sets must be justifiable. Always ensure that the clinical documentation for the visit warrants the amount of sets provided.
Are you interested in learning more about medical billing? Here are some additional tips!
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