Acupuncture has been gaining popularity as a holistic and alternative treatment for various ailments. Many patients seek relief from chronic pain, anxiety, and other health issues through acupuncture sessions. However, despite the growing demand for acupuncture services, practitioners often face challenges when it comes to billing and reimbursement. Let’s find out the top reasons for acupuncture why you’re not getting paid for acupuncture services.

1. The Problem: Inaccurate Acupuncture CPT Codes

One of the top reasons acupuncturists struggle to receive payment for their services is the inaccurate use of Acupuncture Current Procedural Terminology (CPT) codes.

The correct application of CPT codes is crucial for accurate billing, timely payments, and maintaining a healthy revenue stream for your acupuncture clinic. When providers practitioners find it challenging to select the right CPT codes for their services, it can result in several issues, including:

• Underbilling: Using codes that do not adequately reflect the services provided can lead to underbilling, causing your clinic to miss out on deserved revenue.
• Claim Denials: Insurance companies are stringent when it comes to accurate coding. Incorrect codes can lead to claim denials, delays in payment, and increased administrative burdens.
• Audit Risks: Inaccurate coding can raise red flags during audits, potentially leading to legal and financial consequences.

The Solution: To overcome these challenges, consider implementing the following solutions in your acupuncture clinic:

• Invest in Staff Training: Ensure that your staff, including billing and coding professionals, are well-trained in CPT codes related to acupuncture services. Continuous education and regular updates on coding changes are essential.
• Utilize Technology: Embrace acupuncture software that includes built-in coding assistance. These tools can help your team select the correct CPT codes for each patient encounter, reducing errors.
• Documentation is Key: Accurate coding begins with thorough documentation. Train your practitioners to document each session comprehensively, including the type of acupuncture performed, the number of needles used, and the duration of the session.
• Regular Auditing: Conduct regular internal audits of your coding practices to identify and rectify inaccuracies proactively.
• Stay Informed: Keep yourself updated with the latest coding changes and guidelines. Subscribe to coding newsletters, attend workshops, or join professional organizations to stay informed.

2. The Problem: Improper Use of Multiple-Unit Codes

One common mistake made by acupuncturists is the misuse of multiple-unit CPT codes. These codes are designed to account for multiple units of a specific service provided during a single session. Using them incorrectly can result in inaccurate billing and subsequent payment issues.

For instance, you have a patient undergoing a 75-minute acupuncture session that includes electrical stimulation therapy. Proper coding involves the use of the following CPT codes and units:

• 97810 Initial Acupuncture
• 97811 Subsequent Unit of Acupuncture Per Additional 15 Minutes
• 97813 Acupuncture with Electrical Stimulation (per session)

Now, let’s break down the coding for this 75-minute session:

• 1 Unit of 97810 Initial Acupuncture for the initial insertion of needles, covering the first 15 minutes of the session.
• 4 Units of 97811 Subsequent Units of Acupuncture Per Additional 15 Minutes to account for the remaining 60 minutes (4 units x 15 minutes each).
• 1 Unit of 97813 Acupuncture with Electrical Stimulation to denote the use of electrical stimulation therapy during the session.

So, for this 75-minute visit, the correct coding would be:

• 1 Unit 97810 Initial Acupuncture
• 4 Units 97811 Subsequent Unit of Acupuncture Per Additional 15 Minutes
• 1 Unit 97813 Acupuncture with Electrical Stimulation

This coding accurately represents the 75-minute session, ensuring proper billing and adherence to coding guidelines. It’s important to note that the use of the corresponding units is crucial for precise medical billing and compliance.

The Solution:            

• Documentation Precision: Accurate coding begins with precise documentation. Train your practitioners to document each session meticulously, including the rationale for using multiple units when applicable.
• Acupuncture Software: Invest in acupuncture practice management software that provides coding and billing assistance. These tools can help your team select the correct CPT codes and indicate the appropriate number of units for each patient encounter.

3. The Problem: Ineligible Insurance Coverage

Another significant challenge acupuncturists face is navigating insurance coverage for acupuncture services.

Until January 2020, Medicare did not cover acupuncture treatments. However, that month the Centers for Medicare and Medicaid Services (CMS) announced a change.

‘We are dedicated to increasing access to alternatives to prescription opioids and believe that covering acupuncture for chronic low back pain is in the best interest of Medicare patients,’ said CMS Principal Deputy Administrator of Operations and Policy Kimberly Brandt in a press release.

Medicare Part B now covers up to 12 acupuncture visits in 90 days for chronic low back pain. If patients show improvement during those first 12 sessions, eight additional sessions may be covered, for a maximum of 20 acupuncture treatments in a 12-month period.

The cost for each session would be the standard 20% of the Medicare-approved amount after meeting the Part B deductible.

The Solution: Ensure the patient has eligible insurance coverage for acupuncture services you’re providing. How to do that?

• Review the Patient’s Health Insurance Policy: The first step in addressing this issue is to review the patient’s health insurance policy. Understanding the coverage details, including which therapies are included and excluded, can help you make informed decisions regarding their healthcare options.
• Contact the Insurance Provider: You should proactively contact their insurance providers to inquire about acupuncture coverage. Sometimes, insurance companies offer supplementary plans or riders that can be added to existing policies to cover acupuncture and other complementary therapies.
• Explore Alternative Payment Methods: If insurance coverage remains unavailable, You can provide alternative payment methods to patients. Some acupuncturists offer flexible payment plans, sliding scale fees based on income, or package deals that can make acupuncture treatments more affordable.

Insurances Accepting Acupuncture Services

While insurance coverage for acupuncture can vary significantly depending on the plan, services covered, and location, here is a list of some insurance providers that may offer coverage for acupuncture services:

• Blue Cross Blue Shield
• Aetna
• Cigna
• UnitedHealthcare
• Kaiser Permanente
• Humana

Most Used Acupuncture CPT Codes & When To Apply Multiple Units

To mitigate billing issues and ensure accurate reimbursement for acupuncture services, providers must be familiar with the most commonly used acupuncture CPT codes and when to apply multiple units. Here are some of the frequently used CPT codes in acupuncture:

• 97810 – Acupuncture, one or more needles, without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient.
  • When to Apply Multiple Units: This code should be billed for each additional 15 minutes of one-on-one patient contact during the same session.

• 97811 – Acupuncture, one or more needles, without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient.
  • When to Apply Multiple Units: Use this code for every additional 15 minutes of personal one-on-one patient contact after the initial 15 minutes.

• 97813 – Acupuncture, one or more needles, with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient.
  • When to Apply Multiple Units: Bill this code for each additional 15 minutes of personal one-on-one patient contact during the same session when electrical stimulation is used.

• 97814 – Acupuncture, one or more needles, with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient.
  • When to Apply Multiple Units: This code should be used for every additional 15 minutes of personal one-on-one patient contact after the initial 15 minutes when electrical stimulation is employed.

Conclusion

Ensuring accurate acupuncture billing is paramount for maintaining a healthy revenue cycle in your acupuncture practice. While the process of billing the correct acupuncture CPT codes may seem intricate, it is essential to prevent delays and claim denials that can adversely impact your practice’s financial well-being.

To streamline your medical billing process and reduce the risk of claim denials, consider integrating zHealth Acupuncture Software into your practice. Our advanced software solution is designed to simplify acupuncture billing, making it easier for acupuncturists to accurately code and submit claims, ultimately leading to faster payments and improved revenue management.

Don’t let billing complexities stand in the way of your practice’s success—choose zHealth Acupuncture Software and optimize your revenue cycle today.