Acupuncture CPT CODES 97810, 97811, 97813, 97814

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Procedure code and Description



• 97810: Acupuncture, one or more needles, without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient

• 97811: Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles

• 97813: Acupuncture, one or more needles, with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient

• 97814: Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles


Acupuncture: A chiropractic provider may not provide acupuncture services until certified by the Florida Board of Chiropractic Medicine. Acupuncture is reported based on 15 minute increments of personal (face-to-face) contact with the patient, not the duration of acupuncture needle(s) placement. If no electrical stimulation is used during a 15 minute increment, use 97810 or 97811. If electrical stimulation of any needle is used during a 15 minute increment, use 97813 or 97814. Only one code may be reported for each 15 minute increment. Use either 97810 or 97813 for the initial 15 minute increment. Only one initial code is reported per day.

The FEP does not include benefits for acupuncture when performed by a chiropractor.



Covered Services for Medicare Advantage Members:

According to the Centers for Medicare & Medicaid Services (CMS) Internet-only manual, Publication 100-02 Medicare Benefit Policy Manual, chapter 15, section 30.5, chiropractors’ services extend only to treatment by means of manual manipulation of the spine to correct a subluxation. All other services furnished or ordered by chiropractors are not covered. Chiropractors are not limited to any specific procedures and may render services as they feel necessary, but according to CMS guidelines; the benefit will only cover manual spinal manipulation, which includes procedure codes: 98940, 98941, and 98942.

The following procedure code ranges will deny for chiropractors as non-covered services:

• 00100 through 98929

• 98943 through 99607

• A0021 through V5364


Questions and Answers

1 Q: Acupuncture is not covered by Medicare, but can members still have the treatment?
A: Some Medicare Advantage members have a supplemental benefit package with coverage for acupuncture.
2 Q: Does CMS have new limited coverage for acupuncture?
A: A new NCD 30.3.3 Acupuncture for Chronic Lower Back Pain (cLBP) has coverage only for chronic lower back pain, effective January 21,2020. All other acupuncture remains non-covered.

3 Q: Is auricular peripheral nerve simulation covered?
A: The service for auricular peripheral nerve simulation (CPT code 64999) will be denied as non-covered. This service is not a covered Medicare benefit because acupuncture does not meet the definition of reasonable and necessary under Section 1862(a) (1) of the Act. ANSiStim, E-Pulse, Neurostim system/NSS, P-Stim, and NSS-2
Bridge, other current or future devices when used for the procedure electro-acupuncture or auricular peripheral nerve stimulation, would also be considered a non-covered service. Any ear or auricular electrical devices (e.g., DyAnsys®) are also non-covered by Medicare as electrical acupuncture.
2021 Medicare Product Acupuncture Benefit Changes
Beginning January 1, 2021, two separate benefits, with separate accumulations, will apply to acupuncture services provided to subscribers enrolled with a Medicare Advantage or Platinum Blue (Medicare Cost) plan.
Medicare Eligible Benefit
The Centers for Medicare & Medicaid (CMS) announced that acupuncture for low back pain is a covered benefit beginning in January 2020. Twenty acupuncture (20) visits are covered within a rolling 12-month period. Acupuncture services will only be allowed if billed for diagnosis codes listed in NCD 30.3.3. Providers must accurately point the correct diagnosis to each claim line for dates of service in 2021 to apply the appropriate benefit. Acupuncture services pointed to pain diagnoses other than those in NCD 30.3.3 will process under the Supplemental Benefit described below.
Supplemental Benefit
Blue Cross and Blue Shield of Minnesota (Blue Cross) will offer a supplemental benefit for acupuncture services for physical pain diagnoses other than low back pain. Acupuncture services for diagnoses unrelated to physical pain will not be covered. Providers must accurately point the correct diagnosis to each claim line for dates of service in 2021 to apply the appropriate benefit. This benefit is limited to 20 visits per calendar year.
Reimbursement Allowance
The reimbursement for Medicare eligible acupuncture for Medicare Advantage plans will be as follows:
• Professional claim: the contracted Medicare fee schedule allowance
• Facility claim: contracted Medicare allowance
 The reimbursement for non-Medicare eligible acupuncture for Medicare Advantage plans will be as follows:
• Professional claim: the contracted Medicare fee schedule allowance
• Facility claim: 35% of billed charges based on the provider billing the usual and customary charge
The reimbursement for Medicare eligible acupuncture for Platinum Blue (Medicare Cost) plans will be as follows:
• Professional claim: the contracted Medicare fee schedule allowance
• Facility claim: Medicare is primary, Blue Cross will coordinate based on Medicare processing
The reimbursement for non-Medicare eligible acupuncture for Platinum Blue (Medicare Cost) plans will be as follows:
• Professional claim: the contracted commercial fee schedule allowance
• Facility claim: 100% of billed charges based on the provider billing the usual and customary charge Eligible providers
Must be under supervision of a licensed Physician; Independent Acupuncturists are not covered. Physicians as defined in 1861(r)(1) of the Social Security Act (the Act) may furnish acupuncture in accordance with applicable state requirements.
Physician assistants (PAs), nurse practitioners (NPs)/clinical nurse specialists (CNSs) (as identified in 1861(aa)(5) of the Act), and auxiliary personnel may furnish acupuncture if they meet all applicable state requirements and have:
• a masters or doctoral level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine (ACAOM); and,
• a current, full, active, and unrestricted license to practice acupuncture in a State, Territory, or  Commonwealth (i.e. Puerto Rico) of the United States, or District of Columbia.
• Auxiliary personnel furnishing acupuncture must be under the appropriate level of supervision of a physician, PA, or NP/CNS required by our regulations at 42 CFR §§ 410.26 and 410.27.

Guideline from BCBS

Acupuncture and an initial evaluation (for a new patient) is covered when rendered by a licensed doctor of acupuncture (D. Ac.) or physician (State of Rhode Island-licensed MD or DO)* only. Acupuncture assistants are not recognized for separate reimbursement and are therefore considered inclusive of the acupuncture reimbursement.

An initial evaluation (99201-99205) is allowed only for new patients. According to CPT guidelines, a new patient is one who has not received any professional services from the physician within the past three years.

The following services are not covered:

** **cupuncture with electrical stimulation;
** **djunctive therapies, such as but not limited to moxibustion, herbs, oriental massage, etc.;
** **cupuncture when used as an anesthetic during a surgical procedure;
** Precious metal needles (e.g., gold, silver, etc.);
** **cupuncture in lieu of anesthesia;
** **ny other service not specifically listed as a covered service.

*Acupuncture services may be rendered by a physician (MD or DO) when the following Rhode Island Department of Health criteria has been met:

2.2 Any physician licensed in Rhode Island under the provisions of Chapter 5-37 who seeks to practice medical acupuncture as a therapy shall comply with the following:

2.2.1 Meet the requirements for licensure as a doctor of acupuncture set forth in the Rules and Regulations for Licensing Doctors of Acupuncture and Acupuncture Assistants promulgated by the Department of Health; or 2.2.2 Successfully complete a course offered to physicians that meets the requirements set forth in these regulations and includes no less than the following:

a) a minimum of three hundred (300) hours of formal instruction;

b) a supervised clinical practicum incorporated into the formal instruction required in subsection 2.2.2(a) (above).

Acupuncture is a covered benefit for those groups who have purchased the acupuncture rider or who have an acupuncture benefit. Please refer to the appropriate Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable acupuncture benefits/coverage. Rhode Island-mandated benefits do not apply to Plan 65, FEHBP, and Medicare Advantage plans. Selffunded groups may or may not choose to follow state mandate(s).

Acupuncture is the practice of piercing the skin with needles at specific body sites to induce anesthesia, to relieve pain, to treat various nonpainful disorders, and to alleviate withdrawal symptoms of opioid dependence. Acupuncture has also been used or proposed for a large variety of indications.

Acupuncture is a traditional form of Chinese medical treatment that has been practiced for over 2000 years. It involves piercing the skin with needles at specific body sites. The placement of needles into the skin is dictated by the location of meridians. These meridians, or channels, are thought to mark patterns of energy, called Qi (Chi), that flow through the human body. According to traditional Chinese philosophy, illness occurs when the energy flow is blocked or unbalanced, and acupuncture is a way to influence chi and restore balance. Another tenet of this philosophy is that all disorders are associated with specific points on the body, on or below the skin surface.

Several physiologic explanations of acupuncture’s mechanism of action have been proposed including an analgesic effect from release of endorphins or hormones (eg, cortisol, oxytocin), a biomechanical effect, and/or an electromagnetic effect.

There are 361 classical acupuncture points located along 14 meridians, and different points are stimulated depending on the condition treated. In addition to traditional Chinese acupuncture, there are a number of modern styles of acupuncture, including Korean and Japanese acupuncture. Modern acupuncture techniques can involve stimulation of additional non-meridian acupuncture points. Acupuncture is sometimes used along with manual pressure, heat (moxibustion), or electrical stimulation (electroacupuncture). Acupuncture treatment can vary by style and by practitioner, and is generally personalized to the patient. Thus, patients with the same condition may receive stimulation of different acupuncture points.

Scientific study of acupuncture is challenging due to the multifactorial nature of the intervention, variability in practice, and individualization of treatment. There has been much discussion in the literature on the ideal control condition for studying acupuncture. Ideally, the control condition should be able to help distinguish between specific effects of the treatment and nonspecific placebo effects related to factors such as patient expectations and beliefs and the patient-provider therapeutic relationships. A complicating factor in selection of a control treatment is that it is not clear whether all 4 components (ie, the acupuncture needles, the target location defined by traditional Chinese medicine, the depth of insertion, and the stimulation of the inserted needle) are necessary for efficacy.

CODING Commercial Products

Local providers in the Acupuncture Specialty (053) are able to file only the codes found in this policy.

Providers should not file an E & M service on the same date of service as the acupuncture service unless it meets the definition for use of Modifier -25. The acupuncture codes and services 97810, 97811 include preservice, intra-service and post-service evaluation and management for the typical following factors of history, evaluation, management and chart documentation done as part of the overall daily treatment.

The following CPT codes are covered under the acupuncture rider only:

97810 Acupuncture, 1 or more needles; without electrical stimulation, initial 15 minutes of personal one-onone contact with the patient

97811 Acupuncture, 1 or more needles; without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s)

Evaluation and Management codes are only used for separately identifiable procedures.

99201 Office or other outpatient visit for the evaluation and management of a new patient
99202 Office or other outpatient visit for the evaluation and management of a new patient
99203 Office or other outpatient visit for the evaluation and management of a new patient
99204 Office or other outpatient visit for the evaluation and management of a new patient
99205 Office or other outpatient visit for the evaluation and management of a new patient
99211 Office or other outpatient visit for the evaluation and management of an established patient
99212 Office or other outpatient visit for the evaluation and management of an established patient
99213 Office or other outpatient visit for the evaluation and management of an established patient
99214 Office or other outpatient visit for the evaluation and management of an established patient
99215 Office or other outpatient visit for the evaluation and management of an established patient

The following CPT codes are contract exclusions (non-covered):
97813 Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
97814 Acupuncture, 1 or more needles; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s).

CPT Code Description Fee
97810 Acupuncture $25.50
97811 Acupuncture, additional 15 minutes $18.93
97813 Acupuncture with electrical stimulation $27.27
97814 Acupuncture with electrical stimulation, additional 15 minutes $21.46

3 Comments

  1. Anonymous
    Anonymous on February 7, 2020 at 4:57 pm

    What is the Medicare 2020 fee schedule for Acupuncture?

  2. Anabel Castilla
    Anabel Castilla on September 18, 2020 at 3:07 pm

    Nice blog post .The information which you shared about the topioc is exactly right. I keep visiting your blog. Mindful Billing & Management LLC makes your mission of healing simpler by shouldering the load of insurance billing minutia

  3. Anonymous
    Anonymous on January 5, 2021 at 8:35 pm

    $41