Dry needling is gaining widespread use in physical medicine, chiropractic care, and sports therapy. As more providers offer this technique, understanding how to document and bill accurately for dry needling is essential for compliance and reimbursement. This guide focuses on CPT code 20560, specifically designed for dry needling of 1 or 2 muscles..

What is CPT Code 20560?

CPT 20560 is a procedural billing code established by the American Medical Association for dry needling services involving a limited number of muscles.

CPT Code 20560 Description

According to AAPC, the CPT code 20560 definition is:

“Needle insertion(s) without injection(s); 1 or 2 muscle(s)”

This code applies when dry needling is performed on one or two muscles without the administration of medication, fluid, or anesthetic. It provides a billing mechanism that separates dry needling from trigger point injections or acupuncture.

Key Details:

• Use only when 1–2 muscles are treated.
• No injectable substances should be involved.
• Focuses on needle insertion for therapeutic purposes such as muscle release, reducing pain, or improving range of motion.
• For dates of service on or after 01/01/2020, dry needling should be reported using CPT codes 20560 or 20561. Effective January 21, 2020, Medicare will cover all types of acupuncture including dry needling for chronic low back pain within specific guidelines in accordance with NCD 30.3.3.

Understanding the Use of 20560 CPT Code

CPT code 20560 should be used only under specific conditions:

• The dry needling procedure is aimed at relieving neuromuscular pain, tension, or dysfunction.
• You are treating only 1 or 2 muscles during the visit.
• The treatment does not involve any fluid or injectable agents.
• The muscles treated must be clearly documented in the clinical notes.

This code should not be used interchangeably with trigger point injection codes (like 20552 or 20553), which involve medication delivery.

Dry Needling CPT Codes in 2025

As of 2025, there are two dry needling codes commonly used:

• CPT 20560: Dry needling for 1 or 2 muscles
• CPT 20561: Dry needling for 3 or more muscles

Select the appropriate code based on the number of muscles you treat during a session. Using the incorrect code may result in denials, audits, or lost revenue.

Documentation Requirements for 20560 CPT

Thorough and accurate documentation is vital to support the use of CPT 20560 and ensure compliance and reimbursement. Providers should include:

1. Patient Symptoms and Diagnosis
Record the patient’s presenting complaint (e.g., myofascial pain, muscle spasm, limited range of motion) and ensure it aligns with the medical necessity for dry needling.

2. Muscles Treated
Clearly indicate the one or two muscles targeted during the session. Name the specific muscles and the side of the body (e.g., left trapezius, right gluteus medius).

3. Technique Used
Describe the needle insertion process, including sterile technique, depth, and approach.

4. Therapeutic Purpose
Explain the intended outcome , relief from spasm, improved movement, reduction in localized pain.

5. Patient Consent
Ensure you have written or verbal consent documented in the chart.

6. Progress Over Time

Track and document patient progress if dry needling is repeated across multiple sessions.

Billing Guidelines for CPT Code 20560

To bill CPT 20560 correctly, follow these practices:

1. Use the Correct Place of Service (POS) Code

Most providers will bill this from an outpatient or office setting. Use:

• POS 11 for Office
• POS 22 for Outpatient Hospital/Clinic

2. Attach Appropriate Diagnosis Codes

Pair CPT 20560 with ICD-10 diagnosis codes that justify the procedure. Common examples include:

• M79.1: Myalgia
• M62.838: Other muscle spasm
• M79.7: Fibromyalgia
• M54.5: Low back pain

3. Apply Modifiers When Needed

When billing dry needling, use CPT modifiers to indicate that the procedure is separate and distinct. This is crucial to avoid claim denials when services overlap.

Does CPT Code 20560 Require a Modifier?

CPT 20560 – defined as “Needle insertion(s) without injection(s); 1 or 2 muscles” – is often billed alongside other services or under specific conditions that may require the use of modifiers. Applying the correct modifier ensures your claims are properly processed and reduces the risk of denials or audits.

Below are commonly used modifiers that may apply when billing CPT 20560, along with explanations for when and how to use each:

Modifier 25 – Significant, Separately Identifiable E/M Service

Use this when an evaluation and management (E/M) visit is provided on the same day as the dry needling procedure. To bill both, the E/M must be clearly documented as distinct and medically necessary.

Example: A patient presents with multiple complaints, and after a full assessment, dry needling is performed for a specific condition.

Modifier 59 – Distinct Procedural Service

This modifier is used when CPT 20560 is performed in addition to another procedure that would normally be bundled. Modifier 59 signals that the dry needling is a separate service from the other procedure provided during the same session.

Example: Dry needling is performed on the upper trapezius while manual therapy is performed on the lumbar region.

Modifier 50 – Bilateral Procedure

Apply this modifier if dry needling was performed on both sides of the body (left and right) for the same muscle group.

Note: Always confirm with payer guidelines, as some insurers prefer

Modifiers LT and RT – Left and Right Side

Use LT or RT when dry needling is performed on only one side of the body. This clarifies which side was treated and is especially important when services are billed per side.

Example: Dry needling performed only on the left gluteus medius muscle → use Modifier LT.

 Modifier 76 – Repeat Procedure by Same Provider

Use this when the same provider performs CPT 20560 more than once on the same day, due to a clinical need (e.g., treating different areas or sessions spaced apart).

 Modifier 77 – Repeat Procedure by Different Provider

Use this modifier if another healthcare provider performs the same procedure (20560) again on the same day, due to a separate issue or treatment area.

Modifier 78 – Unplanned Return to Procedure Room (Related Procedure)

Use this if the patient unexpectedly returns for another session of dry needling related to the initial treatment on the same day. 

Modifier 79 – Unrelated Procedure During Postoperative Period

Apply when CPT 20560 is provided during the post-op period of another procedure, but is completely unrelated to the original surgery. 

X Modifiers (Medicare-recognized subset of Modifier 59):

These are sometimes required by Medicare and other payers instead of Modifier 59.

• XE – Separate Encounter
  Use when CPT 20560 is provided during a different patient visit on the same day.
• XS – Separate Structure
  Use when dry needling is performed on a different anatomical site than another service.
• XP – Separate Practitioner
  Use when a different provider performs the dry needling.
• XU – Unusual Non-Overlapping Service
  Use when the dry needling does not overlap with components of other services billed.

20560 CPT Code Reimbursement

Reimbursement for CPT 20560 varies depending on the payer and location. In general:

• Medicare: As of 2025, Medicare does not cover dry needling in most cases. If billing a Medicare patient, an Advanced Beneficiary Notice (ABN) should be provided.
• Private Insurance: Many private payers do recognize dry needling, especially when properly documented and linked to covered diagnoses.

Average Reimbursement Rates:

• Medicare Fee Schedule (non-covered): Patient may self-pay, typically $35–$50
• Private Insurance Payouts: Range from $50 to $75 per session, depending on plan contracts

Verify payer-specific guidelines before providing the service. Reimbursement also depends on proper use of codes and supporting documentation.

How to Maximize Reimbursement for CPT 20560

To ensure maximum reimbursement and reduce denials:

1. Verify Patient Coverage

Before providing dry needling, verify if the patient’s insurance plan covers CPT 20560. If it doesn’t, inform the patient and offer self-pay options.

2. Use an ABN Form for Medicare

Because Medicare generally does not cover dry needling, have patients sign an Advanced Beneficiary Notice (ABN) to acknowledge their financial responsibility.

3. Use Accurate Coding

Don’t under-code or over-code. If more than 2 muscles are treated, switch to CPT 20561. Coding errors are a major cause of denials.

4. Educate Your Billing Team

Ensure your coders and billers understand the difference between CPT 20560, 20561, and other musculoskeletal codes such as 20552 and 20553 (used for injections, not dry needling).

5. Document for Medical Necessity

Always include the rationale for treatment in your notes, such as diagnosis, specific muscles involved, symptoms being treated, and expected outcomes.

Common Mistakes to Avoid When Billing CPT 20560

• Using 20560 when more than two muscles are treated, this can lead to underbilling.
• Failing to differentiate dry needling from trigger point injections.
• Not confirming payer coverage or skipping the ABN with Medicare.
• Omitting clear documentation or muscle identification.

Neglecting to apply modifier 59 when required.

Conclusion

Understanding and correctly using CPT code 20560 is key to ensuring you receive proper reimbursement for dry needling treatments. With thorough documentation, accurate coding, and payer verification, chiropractors and physical medicine providers can integrate dry needling into their services without facing claim denials or compliance issues.

As dry needling continues to grow in popularity, mastering the billing process now will help future-proof your practice.

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A Complete Guide To Acupuncture Billing And Coding

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FAQs About CPT Code 20560

Q1: Can CPT 20560 be billed alongside manual therapy codes?

A1: Yes, but only if you use modifier 59 to indicate that the dry needling is a separate and distinct procedure.

Q2: Does Medicare cover CPT code 20560?

A2: Generally, no. As of 2025, Medicare does not consider dry needling a covered service. Always inform patients and obtain an ABN.

Q3: What’s the difference between CPT 20560 and 20561?

A3: The key difference lies in the number of muscles treated:

• 20560 is for dry needling of 1–2 muscles
• 20561 is for dry needling of 3 or more muscles

Using the correct code is essential for appropriate billing.

Q4: What modifiers are commonly used with CPT 20560?

A4: Commonly used modifiers include:

• Modifier 25 – For separate E/M visits
• Modifier 59 – For distinct procedural services
• LT or RT – To indicate left or right side of the body
• Modifier 50 – For bilateral procedures
• Modifier 76/77 – For repeat procedures (same or different provider)

Q5: What are common billing mistakes with CPT 20560?

A5: Common billing mistakes with CPT 20560 include:

• Missing or incorrect use of modifiers
• Insufficient documentation of medical necessity
• Using outdated codes
• Bundling it incorrectly with other services.

To avoid denials, ensure accurate coding, proper documentation, and confirm payer-specific rules.

Q6: Can I bill CPT 20560 multiple times in a day?

A6: Yes, but it must be medically necessary and appropriately documented. If done by the same provider, use Modifier 76. If performed by another provider, use Modifier 77.

Q7: Do I need patient consent for dry needling under CPT 20560?

A7: Yes, Always document verbal or written consent in the patient’s chart prior to the procedure. This protects your practice and supports billing compliance.