Acupuncture Insurance Billing FAQs: What’s Billable, What’s Not
As far as medical billing and coding goes, acupuncture poses unique challenges. When it comes to diagnosis codes, some insurers allow acupuncture only for pain, others for nearly anything! When it comes to billing codes, there are only a few (97810-97814) – but what about billing for other factors?
As an acupuncture billing service we’re here to answer a few recently asked acupuncture billing questions. Got more for us? Send them to solutions@holisticbillingservices.com.
I saw that there’s a billing code just for needles. Can I use that to bill for the needles used in a treatment session?
Simply put, no. The needle code (A4215 needle, sterile, any size, each) is intended for use when a patient must take home needles for at-home home injections – like a diabetic patient would for insulin. Needles are inherent to the practice of acupuncture treatment, so they can’t be billed as a separate and dedicated line item. Use the acupuncture codes appropriately depending on the set of needles: 97810 initial set, manual, 97811 additional set(s) manual or 97813 initial set, electrical, and 97814 additional set(s) electrical.
If I spend an hour with a patient, can I bill four units of acupuncture?
This common question stems from the fact that the acupuncture billing codes place an emphasis on the practitioner spending 15 minutes of time face-to-face with the patient. Yet in addition to the face-to-face time, each code represents a dedicated set of needle insertions. To bill four units for an hour, you’d have to conduct four separate needle insertions in that span of time! The resting time a patient spends on needles never qualifies for additional units of acupuncture.
Can I bill for the time I spend on the phone with patients?
Yes, but carefully and pay attention to the individual payer reimbursement guidelines. “Non-face-to-face” evaluation and management codes 99441, 99442, and 99443 can be used appropriately for calls initiated by an established patient (or his or her guardian). However, if a call ends with the medical decision for the patient to come to your practice within 24 hours or at the next available urgent visit time, no non-face-to-face code can be recorded. In that case, the call qualifies as a component of the pre-service work for the subsequent E/M service, procedure, and patient visit.
If I insert just one needle on the second set, is that billable as a whole additional set?
Indeed it is. The additional-set codes (97811 and 97814) allow billing for additional sets so long as at least one needle is re-inserted.
Are you interested in learning more about acupuncture billing? Here are some additional tips!
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