As a requirement for billing acupuncture services, the diagnosis of the condition causing the pain, other treatments given and the results of other treatments must be submitted with each claim; therefore, a statement and “See attached documentation” are entered in the Additional Claim Information field (Box 19).
Full Answer
Can an acupuncturist bill Medicare?
There are also additional acupuncture insurance billing requirements to follow, although the ruling has created the impression that any licensed acupuncturist can bill services to Medicare as long as they administer treatment in the presence of a physician, physician, assistant, or nurse practitioner.
How do I Bill for acupuncture?
When acupuncture is covered, we want to bill for it, so bill for every unit of acupuncture. Acupuncture is billed in 15 minute units, and that is divided into acupuncture with and without electrical stimulation. You can only bill an additional unit of either if you’ve billed the first unit. Acupuncturists should bill for all services performed.
Does Medicare cover acupuncture for lower back pain?
While Medicare now covers acupuncture services for lower back pain, there are a number of important conditions that must be met for treatment to be eligible for acupuncture billing. For example, the treatment must be administered under the “adequate supervision” of a physician, physician assistant, or nurse practitioner.
How much does acupuncture cost?
97813 ($42.22): Acupuncture, one or more needles, with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient. 97814 ($34.65): Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles.
Does Medicare Supplement pay for acupuncture?
Since Medicare Supplement plans work alongside Original Medicare coverage, they typically wouldn't cover acupuncture. Even though Medicare Supplement Plan F* provides the most comprehensive basic benefits for Original Medicare's out-of-pocket costs, it would generally not cover acupuncture.
How do I code acupuncture for Medicare?
CMS Covers Acupuncture When Case Meets These Requirements97810 – Acupuncture, one or more needles, without electrical stimulation, initial 15 minutes.97811 – Acupuncture, one or more needles, without electrical stimulation, each additional 15 minutes.More items...•
How many sessions of acupuncture does Medicare cover?
You are covered for up to 12 acupuncture visits in 90 days. Medicare will cover eight additional sessions if you show improvement, which means you can receive up to 20 acupuncture treatments in a calendar year.
Why does Medicare not pay for acupuncture?
Why Doesn't Medicare Cover Acupuncture? Mostly, Medicare doesn't cover acupuncture (outside of relief for chronic lower back pain) because this treatment is still considered naturopathic care. For those with chronic pain in other places, you'll likely need to see a pain management specialist.
Does Medicare require a modifier for acupuncture?
11755 - 04.6 Contractors shall accept and process acupuncture for cLBP claims with the -KX modifier for the 13th through 20th service. NOTE: The 1st through 12th service over a 90-day period do not require the –KX modifier. There is a 20 service maximum per annum for this benefit.
How do you bill acupuncture codes?
E/M services can be billed on the initial patient evaluation. Bill a new patient for their first acupuncture visit using CPT codes 99201 to 99204. E/M services can be billed for periodic follow-up evaluations (every 30 days or every sixth visit using CPT codes 99211 – 99214) with established acupuncture patients.
When did Medicare start covering acupuncture?
2020Is acupuncture covered by Medicare? Acupuncture is the practice of applying tiny needles to specific areas in the body to relieve pain and restore energy flow. In 2020, Medicare began covering acupuncture as a treatment for lower back pain.
Does Medicare cover acupuncture for arthritis?
Acupuncture may be an effective treatment for some health conditions that affect seniors, such as rheumatoid arthritis or chronic lower back pain. Beginning January 21, 2020, Medicare Part B covers acupuncture treatment of chronic lower back pain for up to 12 sessions in 90 days and up to 20 sessions per year .
Is acupuncture and dry needling the same?
Both methods use fine filament needles gently inserted into strategic locations in the body. The fundamental difference between these techniques is that dry needling is based on human anatomy and the neurophysiological principles, while traditional acupuncture is based on traditional chinese medicine.
Does insurance cover acupuncture for neuropathy?
Health Insurance Coverage for Acupuncture Most private health insurance plans have covered acupuncture for years now. And in 2020, government-run insurance programs like Medicare and Medicaid followed suit, adding acupuncture coverage to their list of benefits.
Does acupuncture work for neuropathy?
"It can also help with nerve regeneration and preservation. If there has been nerve damage or diminished sensation, we target treatment in these areas to re-stimulate those nerve fibers." Indeed, studies show that acupuncture is an effective treatment for peripheral neuropathy, with fewer side effects than medications.
Is cupping covered by Medicare?
Does Medicare Cover Cupping? When cupping is performed by a licensed massage therapist or acupuncturist who is within a Medicare Advantage network, your plan may provide some coverage. However, alternative treatments such as cupping aren't typically covered by original Medicare.
How many acupuncture visits are covered by Medicare?
For Medicare-covered acupuncture, guidelines stipulate that up to 12 visits in the first 90 days may be covered for Medicare beneficiaries. Up to eight additional sessions may be covered for patients who demonstrate improvement, but no more than 20 acupuncture treatments may be administered annually.
How long does acupuncture last?
It has lasted 12 weeks or longer . There is no known cause (not related to cancer that has spread, inflammatory, or infectious disease). Pain not associated with surgery or pregnancy. As of current Medicare acupuncture coverage regulations, no other sources of back pain will be covered. However, it’s not that simple.
What is holistic billing?
At Holistic Billing Services, we deal exclusively with holistic healthcare practices like acupuncture, massage therapy, and chiropractic treatment. Our team of experienced billing and coding experts understand the unique needs of holistic practices – such as acupuncturist practices – and can help you take steps to accelerate your revenue cycle management. For any questions about holistic billing, feel free to contact our team today and let us know how we can help your acupuncture practice.
What is the American Society of Acupuncturists' goal?
In early 2021, their goal is to secure bipartisan support for the bill and organize acupuncturist advocacy campaigns to increase awareness of their bill.
Can acupuncturists bill Medicare?
Furthermore, since licensed acupuncturists are not currently included on the list of Medicare provider groups, there is currently no way for them to directly bill Medicare for reimbursement. Hypothetically, if they were added to the list of qualified provider groups, they would be able to bill for eligible services (currently chronic lower back pain).
Can auxiliary personnel bill Medicare?
Following this logic, then, auxiliary personnel cannot directly bill Medicare for any services rendered because they are not the registered Medicare provider. The supervising physician may bill Medicare for acupuncture treatments for lower back pain (with some restrictions), but the acupuncturist cannot do so themselves.
Is acupuncture on Medicare?
Despite several attempts to add acupuncturists to the list of Medicare providers over the past 40 years (most recently with the Acupuncture for Heroes and Seniors Act, introduced in 2015 and reintroduced in 2017 and 2019), none of them have received a committee hearing in Congress.
How many visits to acupuncture office?
Acubiller suggests billing an established patient office visit after 5-6 visits when you need to assess progress, or when the patient presents a new diagnosis.
Does insurance cover neck pain?
While you probably treat patients for a wide variety of conditions, insurance will typically only cover certain ailments – usually pain. Neck and low back pain are the most commonly covered diagnoses. If your patient suffers from those, by all means, bill with those diagnosis codes.
Do acupuncturists have to bill insurance?
Insurance Billing Basics for Acupuncture. If you’ve never billed insurance before, or simply need a refresher, this primer on insurance billing will start you off on the right foot. First and foremost, acupuncturists have to bill separately for each procedure that they do. In a cash practice, it’s common to bill one set amount per treatment, ...
What is acupuncture billing?
A cupuncture billing and coding is among the key specialty billing that involve several complexities that result from constantly varying codes and wide variety of treatments that differ from clinic to clinic. Though pain-related acupuncture treatment is the most common form of treatment that acupuncturists undertake, there are other conditions that some of the Physicians treat, including chronic diseases, dental, mental health, asthma, etc.
Is acupuncture covered by Medicare?
Medically Necessary Acupuncture benefits are available for patients that meet the Centers for Medicare & Medicaid (CMS) criteria for Chronic Lower Back Pain. To determine qualification, a request for prior authorization must be submitted. Supplemental acupuncture benefits are available for patients enrolled in a participating plan. Generally, these services do not require prior authorization unless mandated by the health plan.
What is the Medicare Approved Rate for Acupuncture?
The specific amount Medicare will pay your provider for acupuncture treatment depends on a variety of factors, including the length of each appointment and the specific medical billing codes used.
Does Medicare Cover Acupuncture for Lower Back Pain?
Acupuncture is only covered by Original Medicare Part B if it is for the treatment of chronic low back pain, and the acupuncture treatment must be administered as part of a doctor’s care plan for your pain.
Acupuncture Coverage Under Medicare
During an acupuncture procedure, a practitioner penetrates a patient’s skin with fine needles that are placed at strategic areas. This practice is believed to balance blood flow and stimulate nerves and connective tissue.
Duration of Acupuncture Treatment Covered by Medicare
Medicare Part B plans will cover up to 12 visits in 90 days for the treatment of chronic lower back pain, which meets the following criteria:
Benefits of Acupuncture Treatment
Acupuncture’s roots can be traced back to traditional Chinese medicine, which is a system of health care delivery techniques that include tai chi and the utilization of herbal medicines to address ailments.