Medicare Coverage for Dry Needling At present, Original Medicare benefits do not cover dry needling treatments. This is likely due to the lack of research around the practice and the lack of oversight for its practitioners.
Full Answer
What if Medicare does not pay for dry needling?
If we bill Medicare our regular dry needling fee and it is denied, are we able to provide a discount to the patient since Medicare did not pay or does this become a compliance issue like waiving a copay or deductible would? You would place the estimated cost for the DN on the ABn form.
Why is dry needling in the fee schedule?
Dry needling is in the fee schedule because it is covered by Medicare when performed by a licensed acupuncturist for chronic low back pain for up to a set number of visits (I can’t remember the specific number). *How should the time spent assessing soft tissue prior to inserting the needle be billed?
Do dry needling codes require pre-authorization?
Hummana (in NC) told us the Dry needling codes are “valid and billable” and “do not require pre- authorization” but does this mean it will get paid?? Thanks! That would be insurance carrier specific and you would need to contact each insurance carrier and/or review any of their therapy policies that they may have online.
Are 20561 and 20560 dry needling codes reimbursable?
However, the military's health website still has both dry needling codes (20561 and 20560) listed as codes that are not reimbursed by the military based systems. This was updated 1.1.21 on their no pay list.
Does Medicare cover dry needling in 2022?
Nope. Because dry needling is statutorily excluded from Medicare coverage, you do not have to bill Medicare for dry needling—unless you issue a voluntary ABN and the patient requests that you do so by selecting option two.
How do I bill dry needling to Medicare?
For dates of service on or after 01/01/2020, DRY NEEDLING should be reported with CPT code 20560 and/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.
What conditions are treated with dry needling?
What kinds of pain does dry needling treat?Joint problems.Disk problems.Tendinitis.Migraine and tension-type headaches.Jaw and mouth problems (such as temporomandibular joint disorders or TMD)Whiplash.Repetitive motion disorders (like carpal tunnel syndrome)Spinal problems.More items...•
Is dry needling billable?
The APTA also stated that "currently, there is no CPT code that describes dry needling." Because there was no CPT code to describe dry needling, the APTA recommended that therapists report dry needling using an "appropriate unlisted physical medicine/rehabilitation service or procedure code 97799."
Does insurance pay for needling?
Dry needling of trigger points for the treatment of myofascial pain is considered not covered as the evidence is insufficient to determine the effects of the technology on health outcomes. Dry needling of trigger points for the treatment of myofascial pain is considered not medically necessary.
Is dry needling the same as acupuncture?
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.
How many sessions of dry needling are needed?
How many sessions of dry needling will I need? Results' dry needling patients average 2-3 sessions, and will not use more than 5-6 except in rare circumstances. Often we will use dry needling once or twice per week out of 2-3 visits.
Does dry needling work for nerve pain?
Dry needling is an effective treatment for chronic neuropathic pain with very few side effects. Manage neuromusculoskeletal pain and movement impairments due to myofascial trigger points.
Is dry needling worth it?
Most of the existing research for dry needling supports the practice for relieving mild to moderate pain. In some studies, dry needling provided more relief than a placebo treatment. However, one study showed that dry needling is no more effective than stretching alone to relieve muscle pain.
Is dry needling considered manual therapy?
Dry Needling (Intramuscular Manual Therapy) | Back in Action.
Can you bill dry needling as manual therapy?
Dry needling is a neurophysiological evidence-based treatment technique that requires effective manual assessment of the neuromuscular system. Physical therapists are well trained to utilize dry needling in conjunction with manual physical therapy interventions.
What does CPT code 97140 mean?
Manual therapy techniquesCPT® code 97140: Manual therapy techniques, 1 or more regions, each 15 minutes (Mobilization/manipulation, manual lymphatic drainage, manual traction)
What is CPT code 20561?
20561 – Needle insertion (s) without injection (s), 3 or more muscle (s) Unfortunately, the Centers for Medicare and Medicaid Services (CMS) gave these 2 CPT codes a non-covered status for payment under the Medicare Physician Fee Schedule (MPFS). This meant that if a physical therapist performed dry needling on a Medicare beneficiary who had ...
Is a nonspecific a systemic cause?
nonspecific, in that it has no identifiable systemic cause (i.e., not associated with metastatic, inflammatory, infectious, etc. disease); not associated with surgery; and. not associated with pregnancy. An additional eight sessions will be covered for those patients demonstrating an improvement.
Does Medicare pay for dry needling?
This meant that if a physical therapist performed dry needling on a Medicare beneficiary who had traditional Medicare as their insurance, CMS would not pay for this service. Since dry needling is non-covered by CMS, this means the Medicare beneficiary would be financially responsible for the cost and the provider of the dry needling service (s) ...
Does Medicare cover acupuncture for low back pain?
On January 21, 2020, CMS issued a decision memo for Acupuncture for Chronic Low Back Pain. In the Decision Summary, CMS states the following: “The Centers for Medicare & Medicaid Services (CMS) will cover acupuncture for chronic low back pain under section 1862 (a) (1) (A) of the Social Security Act. Up to 12 visits in 90 days are covered ...
How to get paid for dry needling?
However, there are three things you should do if you want to provide—and receive payment for—dry needling: 1. Check your state practice act. First and foremost, make sure that you’re legally able to perform dry needling under your state practice act. That means two things:
What is the procedure code for dry needling?
That said, not all payers follow Medicare regulations, and it's ultimately up to them if you can bill using these codes. The APTA recommends using procedure code 97799. And we suggest contacting your payers for further guidance on using 20552 or 20553 for dry needling.
What is dry needling in physical therapy?
Back in 2009, the American Academy of Orthopedic Manual Physical Therapists (AAOMPT) decided that dry needling fell within the scope of PT practice: Dry needling is a neurophysiological evidence-based treatment technique that requires effective manual assessment of the neuromuscular system.
What is the APTA advice?
In the above-cited PT in Motion article, Justin Elliott—the APTA’s director of state government affairs—said, “APTA’s advice always is to first determine the insurer’s policy toward dry needling, then, if the company will pay for it, to ask what code they want you to use.” This advice also appears in the above-cited APTA resource paper: “Physical therapists should check with the insurance payor to see if it has issued any policies regarding billing of dry needling.” In other words, this is a situation where it pays to ask for permission—not forgiveness.
Is dry needling covered by the military?
https://www.tricare-west.co... However, the military's health website still has both dry needling codes (20561 and 20560) listed as codes that are not reimbursed by the military based systems .
Does dry needling help with muscle tension?
Research supports that dry needling improves pain control, reduces muscle tension , normalizes biochemical and electrical dysfunction of motor end plates, and facilitates an accelerated return to active rehabilitation. And the American Physical Therapy Association agrees with that statement.
Does Medicare pay for dry needling?
Medicare definitely doesn't pay for dry needling, and other payer coverage (i.e., state and commercial) varies. To find out if your contracted payers reimburse dry needling services, you'll need to contact them directly.
General Information
CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Pain Management. Coding Information: Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits.
ICD-10-CM Codes that Support Medical Necessity
The use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in the attached determination.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
What kind of pain does dry needling treat?
Dry needling is used to increase range of motion that may be limited due to muscle tightness or scar tissue.
Why do we need to dry needling?
Dry needling is used to increase range of motion that may be limited due to muscle tightness or scar tissue. Dry needling may also treat: Jaw and mouth problems (such as temporomandibular joint disorders or TMD) Repetitive motion disorders (like carpal tunnel syndrome)
Why do we need needles?
The needles are used to stimulate the tissue, not to inject medication. Pain affects how your body moves. It is thought that dry needling changes the way the brain and muscles talk to each other to let the system return to a more normal movement pattern.
How long does a needle stay in a muscle?
Shorter periods of time would mean that needle would stay in the muscle for seconds, while longer periods could mean 10 to 15 minutes.
What is dry needling in physical therapy?
One of those techniques, dry needling, utilizes a solid filament needle inserted into the muscle. How does this work?
What is dry needling vs acupuncture?
Acupuncture is based in Eastern medicine, and focuses on the flow of Qi, or energy, along meridians for the treatment of diseases. Dry needling is a Western approach to treating pain and dysfunction in musculoskeletal conditions and serves as a reset button, ...
How does a needle work?
Needles are inserted and manipulated and removed or left in for a period of time. The needle elicits a local twitch response followed by the relaxation of the muscle. There may be a cramping, aching sensation or slight discomfort that lasts a few seconds.
Can dry needling help with lumbar pain?
Any patient that has pain and/or movement dysfunction due to a musculoskeletal condition can use dry needling to reduce pain. This includes any muscle where a trigger point is located, chronic pain, lumbar pain, neck pain, shoulder pain, headaches/migraines, whiplash and plantar fasciitis.
Melt away your compliance confusion with this Medicare advice
Adhering to Medicare regulations—especially as they evolve in perpetuity—is a titanic task, even for the most seasoned billers and compliance aficionados.
2022 Proposed Rule
Great question! CMS’s comment period closes September 13, 2021. So, time is of the essence! To make it easier on you, we put together a free and totally customizable template you can use to submit your comments to CMS.
CQ and CO Modifiers
Yep! If a PT and PTA provide treatment in tandem, you can bill that service without the CQ modifier—just be sure to explain that in your documentation! (Keep your eye on the WebPT blog for an article that explains this in more detail.)
Assistant Supervision
From what we understand, a PT must oversee a PTA and an OT must oversee an OTA for Medicare and all other insurance purposes. With that said, it’s important to check out your state’s specific supervision requirements. Check out this resource (courtesy of Gawenda) to learn more about supervision requirements.
Therapy Threshold
Nope! Remember that Medicare pays for medically necessary treatment—even when the charges surpass the therapy threshold and the medical review threshold. So, if you’re providing medically necessary care to your patient, simply bill with the appropriate therapy modifier (i.e., GP, GO, or GN) and the KX payment modifier.
MIPS
Per Gawenda, certified rehab agencies (e.g., outpatient rehab facilities) cannot participate in MIPS because the therapists who work within these settings submit claims using UB-04 claim forms. MIPS only applies to professionals who submit claims on CMS-1500 claim forms.
Dry Needling
Generally speaking, no. Most major national payers (including Medicare) do not pay for dry needling. If you’re unsure if the commercial carriers you’re contracted with pay for dry needling, refer to your contract or call the carriers’ provider representatives to check.