CPT Procedure Codes
As of January 1st, 2005, the CPT codes that Acupuncturist's can use to bill health insurance companies have changed nationwide. There are very few insurance companies that can be directly billed for Acupuncture in PA, but they do exist. Additionally, both Auto Accident insurance and Workman's Compensation mandatorily cover Acupuncture in PA under Act 6.
HCFA Form Update
To get a good understanding we'd advise reading this article in the last issue of Acupuncture Today. Here are the basics of what is soon to change.
- As of Jan. 1, 2007, all insurance companies are required to accept the existing CMS-1500 (HCFA) form and the new one (dated 08/05 on the bottom-right corner of the form). Practitioners may continue using the old form until the end of March 2007 if they wish.
- As of April 1, 2007, all claims submitted to insurance companies are required to be printed on the new HCFA form. The old form will no longer be accepted.
- The new form requires use of your NPI in reference to the provider/practitioner and those who refer patients to the provider. After May 23, 2007, all submitted CMS-1500 forms must include an NPI number.
National Provider Identifier (NPI)
- To obtain an NPI for free and acquired instantly through the Centers for Medicare and Medicaid Services' National Plan and Provider Enumeration System. Online, go to: https://nppes.cms.hhs.gov/NPPES/Welcome.do
- Or call 1-800-465-3203.
Below are the codes currently available to Acupuncturist's and a brief explanation as to how to use them.
| CPT Codes | |
| 99201-205 | Initial Office Consultation (not treatment) |
| 99211-215 | Review Office Consultation (not treatment) |
| 97810 | Acupuncture without Electrical Stimulation - 15 minutes |
| 97811 | Acupuncture without Electrical Stimulation - Additional 15 mins |
| 97813 | Acupuncture with Electrical Stimulation - 15 Minutes |
| 97814 | Acupuncture with Electrical Stimulation - Additional 15 Minutes |
99201-05 & 99211-15: These can be used by most practitioners including MDs, Chiropractors and Acupuncturists. It does not include treatment, it is simply the time spent in assessing a patient's condition and doing an intake. The first is for the initial intake, the second is if you spend a lot of time doing a re-assessment of the patient.
97810 & 97811: These two codes go together. 97810 is your general Acupuncture treatment code. It includes 15 mintues of actual time with a patient performing treatment. 97811 is for any additional 15 minutes spent administering treatment (not the time the patient is marinating on the table). You cannot use 97811 without using 97810 first. For example, if you just do a front treatment and nothing else, use 97810. If you do both a front and back treatment, you should use both codes.
97813 & 97814: These codes are used identically as 97810-11 except they are for when you use electrical stimulation on one or more needles. Again, the first 15 minutes of treatment are covered under 97813 and then only if you do additional needling with stim should you use 97814 (in addition to 97813).
We cannot list here the amount you should charge for any of the above services. Use your own judgement and be fair.