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CPT Codes for Acupuncture: Categories & CPT Codes

Introduction to Current Procedural Terminology Codes

Current Procedural Terminology codes, commonly referred to as CPT codes, are used for coding both invasive and non-invasive healthcare procedures. CPT codes are essential for managing medical records, carrying out insurance procedures, and updating epidemiological data. CPT codes are classified on the basis of their composition and their application in the healthcare setup. CPT codes are classified into the following categories.

  1. Category I CPT Codes

CPT codes present in this category are used for encoding medical and surgical procedures carried out by qualified healthcare professionals. These procedures, services, devices, and medications are documented and approved by the US Food and Drug Administration (FDA). Category I codes are five-digit numerical. For instance, 90716 CPT code is used for encoding the administration of the chickenpox vaccine.

  1. Category II CPT Codes

Also called ‘performance measurement codes’, category II CPT codes are used for encoding the performance and quality of the care provided. These codes comprise numbers and alphabets. For instance, 3008F is a category II code used for indicating the documentation of body mass index (BMI).

  1. Category III CPT Codes

Similar to category II codes, category III CPT codes are also composed of numbers and alphabets. These codes represent advancements in technology, and newer procedures and services. These codes are yet to be approved by the FDA and healthcare professionals. The codes remain viable for a period of five years, after which these are discarded. In case these codes are approved, the codes are placed in category I. For instance, 0256T represents implantation of the prosthetic valve delivered via catheter using an endovascular approach. [1]

Current Procedural Terminology Codes for Acupuncture Services

Acupuncture is a common form of complementary and alternative medicine (CAM) therapy. The traditional practice of acupuncture involves the use of needles to stimulate acupuncture points on the body. This non-pharmacologic treatment improves the flow of energy, also called ‘qi’ in ancient Chinese medicine, through the meridian channels. Different acupuncture points along the meridian channels are used for different health conditions. Chronic pain is one of the most common health ailments acupuncture is famous for. [2] Similar to other healthcare procedures, acupuncture services are recorded using the CPT codes. CPT codes for acupuncture services are listed in table 1. [3, 4] 

Code CPT Description of Billing Services
97810

Use of one or more acupuncture needles

A separate code for the cost of needles is not included 

The code indicates 15 minutes of direct contact with the patient at the start of treatment

Electrical stimulation is not involved

97811

Use of one or more acupuncture needles

A separate code for the cost of needles is not included 

The code indicates 15 minutes of direct contact with the patient at the start of treatment

An additional 15 minutes of direct contact with the patient should involve the insertion of a new needle or reinsertion of a previous one

Electrical stimulation is not involved

This add-on code shall be used when a new needle or re-insertion of a previous needle is performed in conjunction with the primary procedure

Additional procedures shall be listed along with the primary CPT code

97813

Use of one or more acupuncture needles

A separate code for the cost of needles is not included 

The code indicates 15 minutes of direct contact with the patient at the start of treatment

Electrical stimulation is involved

97814

Use of one or more acupuncture needles

A separate code for the cost of needles is not included 

The code indicates 15 minutes of direct contact with the patient at the start of treatment

An additional 15 minutes of direct contact with the patient should involve the insertion of a new needle or reinsertion of a previous one

Electrical stimulation is involved

This add-on code shall be used when a new needle or re-insertion of a previous needle is performed in conjunction with the primary procedure

Additional procedures shall be listed along with the primary CPT code

A4212 Use of non-coring or stylet acupuncture needles 
A4215Use of sterile needles 
G0283Unattended electrical stimulation of the acupuncture points
S8930Represents the electrical stimulation of auricular acupuncture points 

Prerequisites of CPT Codes for Acupuncture Services 

Certain points shall be considered before recording CPT codes for acupuncture tools, procedures, and services. The considerations are listed down below. [3, 4]  

  1. Only a single initial CPT code can be reported in one day. These codes represent an increment of 15 minutes of personal one-to-one contact with the patients. The initial CPT codes are 98710 and 98713. 
  2. Medical Unlikely Edits (MUE) values refer to the maximum units of acupuncture procedures that are allowed in a single day. MUE values of the above-mentioned CPT codes are listed down below.
Code CPT MUE Value
978101
978112
978131
978142
S89303
  1. The costs of needles are not reported separately, as previously mentioned. Rather, the cost of needles is incorporated into the practice expense (PE).  
  2. When performed along with the acupuncture services, electrical stimulation shall not be reported separately. However, modifiers are often used for reporting services that do not correspond to the CPT codes. Modifiers can be used when electrical stimulation is performed separately and distinctly from the documented acupuncture procedure. 
  3. Individuals who receive acupuncture services shall be 18 years or older.
  4. The acupuncturists shall be state-licensed and well-qualified.
  5. Evaluation and management services (EM) are reported separately only when the patient requires a significant and distinct EM service.  
  6. Only time duration of direct one-to-one contact shall be recorded. Time spent away from the patients, such as attending another patient, shall not be documented and billed. 

Conclusion

CPT codes are used by healthcare professionals, insurance providers, and epidemiologists to document, report, and bill medical and surgical procedures, services, and the use of drugs and devices. CPT codes are primarily comprised of five digits that are specified for a certain reportable and billable procedure. Similar to other healthcare providers, well-qualified and state-licensed acupuncturists are also required to use CPT codes to report the procedures performed. Only one initial CPT code is allowed to be reported in a single day. Modifiers are used for indicating separate and distinct procedures performed. 

Références 

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865623/
  2. https://www.ncbi.nlm.nih.gov/books/NBK532287/ 
  3. https://www.chpw.org/wp-content/uploads/content/provider-center/training/Acupuncture_Billing_Guideline_WAH_and_IMC_-_final_2019-11-25.pdf 
  4. https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/COMM-Acupuncture-Policy.pdf 

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