As acupuncture clinics expand their offerings to include more evidence-based and therapeutic services, dry needling is quickly becoming a sought-after treatment, especially for chronic pain and musculoskeletal issues. If you offer dry needling in your practice, understanding CPT code 20561 is critical for correct billing and optimal reimbursement.

This guide breaks down everything you need to know about CPT 20561, including its definition, documentation tips, Medicare coverage, and real-world billing strategies.

What is CPT Code 20561?

CPT Code 20561 is used to report dry needling involving 3 or more muscle groups. It falls under the category of therapeutic interventions performed by healthcare professionals trained in physical medicine techniques.

20561 CPT Code Description:

According to ACA, CPT code 20561 description​ is ”Needle insertion(s) without injection(s); 3 or more muscle(s)”. Also known as “dry needling” or “trigger point acupuncture”.

This code is distinct from 20560, which covers 1–2 muscle groups. Use 20561 CPT Code only when three or more distinct muscles are treated during a single session.

According to ACA, dry needling codes 20560 and 20561 are neither traditional, time-based acupuncture nor injection procedures. When both “dry needling” (20560-20561) and time-based acupuncture services (97810-97814) are performed on the same encounter, providers should only report the time-based acupuncture code(s) (97810-97014).

What Makes Dry Needling Different from Acupuncture?

Although both involve inserting thin needles into the body, dry needling and acupuncture are not the same, especially from a billing and clinical standpoint.

Here’s what sets dry needling apart:

• Targeted Pain Relief: Dry needling zeroes in on trigger points and muscle knots to relieve myofascial pain, improve mobility, and reduce muscle tension.
• Evidence-Based: Rooted in Western medicine, dry needling is recognized for helping with chronic low back pain, shoulder pain, and sports injuries.
• Functional Focus: It supports functional recovery, a key requirement for insurance reimbursement, especially Medicare.
• Common in Rehab Settings: Dry needling is often used by physical therapists, chiropractors, and MDs/DOs as part of a complete rehab plan

Medicare and Dry Needling: What You Should Know

Since January 2020, Medicare has begun covering CPT code for dry needling specifically for chronic low back pain, under certain conditions. This is a major shift, since Medicare does not generally cover traditional acupuncture, this gives dry needling a unique billing opportunity.

Why Medicare Covers Dry Needling:

• Functional Benefit: Medicare supports treatments that improve daily function and quality of life.
• Targeted Intervention: Dry needling addresses neuromuscular dysfunction, fitting into evidence-based clinical care.
• Performed by Qualified Providers: Must be delivered by providers recognized by Medicare, such as PTs or MDs. Acupuncturists generally aren’t covered unless licensed in another qualified role.  

Important: If you’re billing Medicare, double-check your provider type, state laws, and local Medicare Administrative Contractor (MAC) policies to confirm coverage eligibility.

Key Billing Requirements for 20561

To bill CPT code 20561 appropriately:

• Muscle Count Matters: Document clearly that 3 or more separate muscles were treated.
• No Injections: This code is for needle insertion without injection.
• Documentation Should Include:

• Patient’s condition and symptoms
• Muscles treated and number
• Response to treatment
• Functional goals

20561 CPT Code Reimbursement

1. Medicare:

• Medicare may cover up to 12 acupuncture treatments, including dry needling, in a 90-day period. These treatments are covered under Medicare Part B.
• If you’re a licensed physical therapist or have collaborative agreements, check your local Medicare Administrative Contractor (MAC) for rules.

2. Commercial Insurance Payers:

• Reimbursement varies widely depending on payer policy and provider credentials.
• Some insurers cover dry needling under CPT code 20561 when performed by:
• Physical therapists
• Chiropractors
• Sports therapists
• Many do not reimburse if performed by an L.Ac. (Licensed Acupuncturist), so always verify payer-specific coverage before treatment.

3. Cash-Based Practices:

• If you operate a cash-based acupuncture practice, you can still offer dry needling and bill the patient directly.
• Use a superbill with 20561 for patients who want to submit claims to their insurance on their own.

SOAP Documentation Example for 20561 CPT Code

S – Subjective:
Patient presents with ongoing myofascial pain localized to the cervical and upper thoracic regions. Reports persistent tension, stiffness, and restricted range of motion, particularly after long hours of desk work. Pain is described as dull and achy, rated 6/10.

O – Objective:
Palpation revealed hypertonicity and trigger points in the upper trapezius, levator scapulae, and rhomboid muscles. Limited cervical flexion and rotation noted. No signs of inflammation or acute injury.

A – Assessment:

• Diagnosis: Myofascial pain syndrome affecting cervical and thoracic musculature.
• Indicated for neuromusculoskeletal intervention to address muscle dysfunction and improve mobility.

P – Plan:

• Performed dry needling on 3 distinct muscle groups (trapezius, levator scapulae, rhomboids).
• No injections administered.
• Patient tolerated the procedure well and reported decreased tension post-treatment along with improved range of motion.
• Plan to continue dry needling 1x/week for the next 3 weeks. Will reassess for functional progress and symptom reduction.

This documentation supports accurate billing for CPT Code 20561, which is one of the primary codes listed under the dry needling CPT code 2025 guidelines. Keeping thorough records like this ensures compliance and maximizes reimbursement potential.

Billing CPT Code 20561 Correctly

Correctly billing CPT code 20561—needle insertion(s) without injection(s); 3 or more muscles—requires more than just selecting the code. You must ensure accurate documentation, understand insurance requirements, and apply appropriate modifiers to avoid denials or delays in payment.

When to Use CPT Code 20561

Use CPT 20561 when:

• Dry needling is performed on three or more distinct muscle groups.
• No injectable medication or substances are used.
• The service is part of a medically necessary treatment plan for a musculoskeletal condition, such as:
• Chronic low back pain
• Myofascial pain syndrome
• Postural dysfunction
• Repetitive strain injuries

Documentation Must Include:

Insurance carriers often request detailed notes to justify the service. Your SOAP note and encounter documentation should include:

• Specific muscles treated (at least three)
• Indication for treatment (e.g., chronic low back pain, mobility limitation)
• Type of technique used (dry needling, not acupuncture)
• Patient’s response to previous treatments
• Objective improvements (pain scale, range of motion, function)
• Planned frequency/duration of treatment

Avoid vague phrases like “needles inserted for pain.” Be specific and tie treatment to functional improvement.

Modifiers for CPT Code 20561

Modifiers help provide extra information to payers about the nature of the service and avoid automatic denials. Here are the most commonly used modifiers with 20561:

Modifier -59 (Distinct Procedural Service)

Use modifier 59 when dry needling is provided separately and distinctly from other services on the same day (e.g., manual therapy or E/M).

Example: You perform dry needling and manual therapy during the same session. Bill:

• 20561 – 59
• 97140 (manual therapy)

Modifier 59 tells the payer these were separate services—not bundled together.

Modifier GP (Services Delivered Under a Physical Therapy Plan of Care)

If dry needling is billed under a therapy plan, especially for Medicare or commercial plans that follow CMS guidelines, you may need to attach modifier GP.

This modifier indicates that the service is part of a rehabilitation therapy plan, often required when billing Medicare through physical therapy coverage.

Modifier 25 (Significant, Separately Identifiable E/M)

If an evaluation and management (E/M) service was provided on the same day as dry needling and is significant and separately identifiable, use modifier 25 on the E/M code.

Example:

• 99213 – 25
• 20561

Billing CPT Code 20561: Sample Claim Setup

Limit Misuse of CPT 97811

To ensure compliance and avoid denials, avoid misusing CPT 97811 by adhering to strict billing practices.

• Always Bill CPT 97810 First:CPT 97811 should never be billed without first billing CPT 97810 in the same session. CPT 97811 is a supplementary code, used after the initial acupuncture service (CPT 97810), to reflect additional units of time. Failure to follow this sequence can lead to claim denials.
• Ensure Services are Distinct and Medically Necessary:Only use CPT 97811 when you’ve provided additional manual acupuncture services that are clearly distinct from the initial treatment. The services should also be medically necessary. If additional time was not spent on manual acupuncture or if the treatment was not needed, you should not bill for it.
• Avoid Unnecessary Use of 97811:Don’t inflate your services by billing for additional units unless there is a legitimate clinical need. Billing for unnecessary services is considered fraud and can result in audits, fines, and loss of insurance contracts.
• Consult with Billing Specialists: If you’re unsure about the appropriateness of billing for 97811, consider consulting with a professional billing specialist. They can ensure that you’re following proper coding practices and help navigate complex insurance policies.

Tips to Maximize Reimbursement

1. Verify insurance policies – Not all plans cover dry needling. Get pre-authorization if possible.
2. Know your provider status – Medicare typically requires a PT, DO, or MD to bill for dry needling.
3. Use specific ICD-10 codes – Link the service to specific ICD-10 codes like M54.5 (low back pain) or M79.1 (myalgia) to support medical necessity.

Avoid upcoding or downcoding – Use 20560 for 1–2 muscles, and 20561 only for 3+.

Related CPT Code

While CPT code 20561 is used when dry needling involves 3 or more muscles, CPT code 20560 is used when the procedure is performed on 1 or 2 muscles.

CPT Code 20560 Description:

Needle insertion(s) without injection(s); 1 or 2 muscles

This code applies when:

• Dry needling is performed on only one or two muscle groups.
• No medication is injected.
• It’s part of a therapeutic treatment plan for musculoskeletal issues.

Choosing Between 20560 and 20561 Billing Codes

Using the correct code based on the number of muscles treated is crucial to avoid claim rejections and ensure compliance with payer guidelines.

Tip: Always clearly document which muscles were treated to support the code selection.

Conclusion

Effectively utilizing CPT Code 97811 for acupuncture services can significantly boost your practice’s revenue and ensure compliance with payer requirements. By following the strategies outlined in this guide—accurate time tracking, using correct modifiers, understanding payer policies, and maintaining thorough documentation—you can minimize billing errors, reduce claim denials, and optimize reimbursement opportunities.

Managing the billing process in-house can be time-consuming and complex. That’s where zHealth’s acupuncture software comes in. With its intuitive billing tools and features designed specifically for acupuncture practices, you can streamline your billing process, reduce administrative errors, and ensure timely reimbursement for every session. Whether you’re dealing with CPT 97811, ensuring compliance, or maximizing reimbursements, zHealth is the all-in-one solution that simplifies your practice’s billing needs.

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Try zHealth today and experience how our software can help you get the most out of your CPT Code 97811 reimbursements while improving the efficiency of your acupuncture practice.

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