There are nearly 11,000 CPT codes to account for all the different variations of healthcare treatments. While your chiropractic practice will only need a fraction of these codes, it’s vital that the chiropractic CPT codes are current and accurately reflect the services rendered.
If you’re utilizing chiropractic CPT codes that aren’t appropriate or are keyed incorrectly, your reimbursements can be delayed or your claims can be rejected. In any case, this will disrupt your overall revenue cycle.
Since the CPT codes are updated to some degree every year, let’s review the new changes and essential codes for your chiropractic practice!
New Chiropractic CPT Codes and Changes for 2023
All chiropractic services rendered in 2023 must align with the patient’s condition and can only be billed if they are reasonably and medically needed.
Along with this, you’ll only bill for direct services provided to patients – care and treatment provided by the patient, unskilled assistant, or office technician without the supervision of a licensed provider won’t be recognized as professional therapy.
A majority of the CPT codes that were updated or revised for 2023 deal with simplifying the language used for evaluation/management (E/M) codes for:
- Inpatient and observation care services
- Consultations
- Emergency department services
- Nursing facilities
- Home and residence services
- Prolonged services.
The American Medical Association (AMA) has more details regarding the changes for these categories of care, but some highlights include:
- Editorial revisions to the code descriptors to reflect the structure of total time on the date of the encounter or level of medical decision-making when selecting code level for inpatient and observation care services
- Deletion of lowest level office (99241) and inpatient (99251) consultation codes to align with four levels of Medical Decision Making (MDM)
- Revision to nursing facility guidelines with new “problem addressed” definition of “multiple morbidities requiring intensive management,” to be considered at the high level for initial nursing facility care
- The domiciliary or rest home CPT codes (99334-99340) were deleted and merged with the existing home visit CPT codes (99341-99350)
- A new code (993X0) was created to be analogous to the office visit prolonged services code (99417); this new code is to be used with the inpatient or observation or nursing facility services
Essential Chiropractic CPT Codes and Modifiers for 2023
While there are numerous chiropractic CPT codes, there are four main CPT codes chiropractors use for reimbursements; each code represents a specific region of the spine that was treated. These main codes are as follows:
- 98940: Used for the examination, diagnosis, and manipulative treatment of one to two spinal regions
- 98941: Used for the examination, diagnosis, and manipulative treatment involving three or four spinal regions
- 98942: Used for the examination, diagnosis, and manipulative treatment involving five or more spinal regions
- 98943: Used to report chiropractic manipulation of one or more of the extra-spinal regions
There are additional two chiropractor modifier codes commonly used. These can be attached to certain CPT codes to tell insurance providers that some of the treatments the CPT code describes were slightly altered.
If your selected CPT code requires a modifier but you fail to include it, your claim will likely be denied by the insurance company:
- Modifier 25: This Modifier is used to report a significant and separately identifiable Evaluation and Management (E/M) service on a day when another service was provided to the patient by the same physician or other qualified healthcare professional
- Modifier 59: Use this Modifier to report a procedure or service that was distinct or independent from other non-E/M services performed on the same day
When billing for these chiropractic CPT codes, remember these points:
- Report the initial treatment procedure
- Report the date of the X-ray if it was applied, including the X-ray film
- If an X-ray is unavailable, a physician’s examination may be used to document subluxation. The physical examination record must reflect the subluxation.
- Report subluxation using the recommended ICD-10-CM code
- All treatment procedures should be categorized as maintenance therapy, chronic subluxation, or acute subluxation
Direct Patient-Chiropractor Care CPT Codes
When billing for chiropractic care, you can only quantify the time that is spent with direct patient-chiropractor care; the client waiting for equipment or resting in your office doesn’t qualify as direct care, so it can’t be billed.
Refer to these ranges of chiropractic CPT codes to find the one that is most appropriate for chiropractic services rendered:
- 97032-97039
- 97530-97546
- 97110-97150
Transform Your Medical Billing with HBS!
Staying on top of your chiropractic practice’s appointments, SOAP notes, billing, and coding, all the while delivering care to your patients can be overwhelming. Save time, energy, and streamline your revenue cycle management by bundling your practice management with outsourced insurance and Medicare billing for your chiropractic practice!
As an experienced EMR and insurance billing provider for holistic practices, Holistic Billing Services can help your practice navigate the billing process to minimize denials and increase revenue. With a knowledgeable partner by your side, you can focus more on treating patients to help your chiropractic practice grow rather than worrying about insurance billing.
To learn more about our chiropractic billing services, talk to one of our friendly billing and coding experts today!
Did you know that roughly 30% of medical billing claims are rejected? That’s a significant chunk of your overall healthcare revenue cycle that will cost you in the short and long run. These claims might be rejected for a few reasons – a key one which is inaccurate coding.
That’s why it’s essential for your acupuncture practice to leverage current CPT codes that accurately reflect the services rendered. Having to rework claims results in costly reimbursement delays plus it takes up your time and energy!
If your holistic practice continues to make mistakes with acupuncture CPT codes, you can have increased denial rates and declining insurance reimbursements, which could put your practice at risk. Accurate acupuncture CPT codes and billing practices can help ensure your holistic practice reaches its full revenue potential.
We want to help reduce your medical billing stress, so we’ve compiled a handy reference list of the acupuncture CPT codes to use in 2023. Be sure to bookmark this page so you can easily access it!
Top 4 Essential Acupuncture Billing Codes for 2023
The bulk of the services you will bill to insurance will likely fall under four essential acupuncture CPT codes. Since acupuncture services are always billed in 15-minute increments, your practice will use one code for the initial 15 minutes of service and then a separate code for additional units of time.
Your acupuncture CPT codes will only vary if you include electronic stimulation in your treatment.
- 97810 Initial Acupuncture: Initial 15-minute insertion of needles, personal one-on-one contact with the patient. (Do not report in conjunction with 97813; use one or the other.)
- 97811 Subsequent Unit of Acupuncture: Use one unit per each additional 15 minutes of personal one-on-one contact with the patient after the initial 15 minutes, with re-insertion of needles. (May be used in conjunction with either 97810 or 97813)
- 97813 Initial Acupuncture with Electrical Stimulation: Initial 15-minute insertion of needles, personal one-on-one contact with the patient. (Do not report in conjunction with 97810; use one or the other.)
- 97814 Subsequent Unit of Acupuncture with Electrical Stimulation: Use one unit per each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles. (May be used in conjunction with either 97810 or 97813)
Acupuncture CPT Codes for Medicare
January marks the three-year anniversary of Medicare expanding their coverage options to include acupuncture for treating chronic lower back pain. CPT codes related to billing Medicare for acupuncture treatments are as follows:
- 97810: Acupuncture, one or more needles, without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
- 97811: Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles
- 97813: Acupuncture, one or more needles, with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
- 97814: Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles
- 20560: Services with needle insertion(s) without injection(s) of 1 or 2 muscle(s)
- 20561: Services with needle insertion(s) without injection(s) of 3 or more muscle(s)
Prices will depend on the region of your holistic practice; look up specific codes based on your location here.
Acupuncture CPT Codes for Patients
Medical billing codes for patients can be broken down into two categories, new and returning patients:
2023 Billing Codes for New Patients
Use these acupuncture CPT codes for when your holistic practice receives new patients. As a reminder, a new patient is defined as a patient who hasn’t received professional services from you or another provider of the same specialty who has belonged to your practice within the past three years.
- 99202 Evaluation/Management (Expanded): Presenting problems are of low to moderate severity; requires an expanded problem-focused history, an expanded problem-focused examination, and straightforward medical decision-making; the provider typically spends 20 minutes face-to-face with the patient
- 99203 Evaluation/Management (Detailed): Presenting problems are of moderate severity; requires a detailed history, a detailed examination, and medical decision-making of low complexity; the provider typically spends 30 minutes face-to-face with the patient
- 99204 Evaluation/Management (Comprehensive): Presenting problems are of moderate to high severity; requires a comprehensive history, a comprehensive examination, and medical decision-making of moderate complexity; the provider typically spends 45 minutes face-to-face with the patient
Billing Codes for Returning Patients
These CPT codes for acupuncture can be used for your established patients. Returning patients are those who have received any professional services from you or another provider of the same specialty who has belonged to your practice within the past three years.
- 99212 Evaluation/Management (Limited): Presenting problems are self-limited or minor; requires a problem-focused history, a problem-focused examination, and straightforward decision-making; the provider typically spends 10 minutes face-to-face with the patient
- 99213 Evaluation/Management (Expanded): Presenting problems are of low to moderate severity; requires an expanded problem-focused history, expanded problem-focused examination, and medical decision-making of low complexity; the provider typically spends 15 minutes face-to-face with the patient
- 99214 Evaluation/Management (Detailed): Presenting problem(s) are of moderate to high severity; requires a detailed history, a detailed examination, and medical decision-making of moderate complexity; providers typically spend 25 minutes face-to-face with the patient
Medical Billing Codes for Physical Therapy Treatments
Acupuncture practices use a variety of treatments and modalities to help their patients; your practice may bill for the following:
- 20550 & 20551 Tendon Injection: Single tendon injection for the treatment of fasciitis. Could include multiple injections into a single tendon sheath (CPT code 20550) or the tendon origin (CPT code 20551)
- 20552 & 20553 Muscle Injection(s): Injections involving single or multiple trigger points. Could be used to treat one or two muscles (CPT code 20552) or three or more muscles (CPT code 20553)
- 97010 Heat Therapy: Application of a modality to one or more areas; hot or cold packs
- 97016 Cupping: The use of a vasopneumatic device may be considered reasonable and necessary for the application of pressure to an extremity for the purpose of reducing edema
- 97026 Infrared Therapy: The application of infrared therapy is considered medically necessary for patients requiring the application of superficial heat in conjunction with other procedures or modalities to reduce or decrease pain/produce analgesia or reduce stiffness/tension, myalgia, spasm, or swelling
- 97110 Therapeutic Exercise: One or more areas, every 15 minutes; therapeutic procedures to develop strength and endurance, range of motion, and flexibility with direct (one-on-one) patient contact
- 97112 Neuromuscular Reeducation: Treatments to restore movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities with direct (one-on-one) patient contact
- 97140 Manual Therapy: Techniques such as mobilization and manipulation, manual lymphatic drainage, and manual traction, one or more regions, every 15 minutes with direct (one-on-one) patient contact
- 97124 Massage Therapy: Includes effleurage, petrissage, and/or tapotement (stroking, compression, percussion) with direct (one-on-one) patient contact
- 97530 Kinetic Activities: Use of dynamic activities to improve functional performance, every 15 minutes with direct (one-on-one) patient contact
Medicare Billing Codes for Principal Care Management (PCM) in 2023
Principal care management involves managing a single, complex chronic condition; the goal here is to deliver a focused treatment and management plan that addresses a patient’s chronic condition.
- 99424: Principal Care Management performed by a physician or non-physician provider for 30 minutes per calendar month
- 99425: Additional 30 minutes per calendar month
- 99426: PCM performed by clinical staff under the direction of a physician or other qualified healthcare professional for 30 minutes per calendar month
- 99427: Additional 30 minutes per calendar month
These codes will allow providers to report care management services for patients with chronic conditions, such as lower back pain, in an effort to improve monitoring these complex health problems.
Transform Your Medical Billing with HBS!
Balancing your acupuncture practice’s appointments, SOAP notes, billing and coding, all the while delivering care to your patients can be overwhelming. Save time, energy, and streamline your revenue cycle management by bundling your practice management with outsourced acupuncture insurance and Medicare billing!
As an experienced EMR and insurance billing provider for holistic practices, Holistic Billing Services can help your practice navigate the billing process to minimize denials and increase revenue. With a knowledgeable partner by your side, you can focus more on treating patients to help your acupuncture practice grow rather than worrying about insurance billing.
To learn more about our acupuncture billing services, talk to one of our friendly billing and coding experts today!
The world of insurance billing is complex, and even more so for holistic practices. Accurate coding and billing practices ensure a streamlined reimbursement process so your practice can get paid and deliver the best care to your patients.
Current Procedure Terminology, or CPT codes, are used to document the majority of medical procedures performed by health care providers. These medical billing codes characterize the type of procedure being done so providers can properly bill insurance companies and receive reimbursements for administered services.
Acupuncture practices use codes that correspond to their unique services. Since services are usually coded in 15-minute increments, you will use one code for the initial 15 minutes of service and then a separate code for additional units of time; acupuncture CPT codes will only vary if you include electronic stimulation in your treatment.
Why is Using the Correct Acupuncture Billing Codes Important?
When it comes to holistic practices, ensuring accurate billing and coding is an important indicator of a practice’s financial health since mistakes can result in costly fines and reimbursement delays. Some estimates find inaccurate coding and billing can result in errors on up to 80% of medical bills – resulting in weeks of editing and resubmissions that delay reimbursement and waste time for your staff.
If your holistic practice continues to make mistakes with acupuncture codes, you can have increased denial rates and declining insurance reimbursements, which could put your practice at risk. Accurate acupuncture CPT codes and billing practices can help ensure your holistic practice reaches its full revenue potential.
New Billing Codes for 2022
The American Medical Association (AMA) stated that 43 percent of changes in the 2022 CPT code set are related to new technology services and the expansion of the proprietary laboratory analyses (PLA) code set; 15 codes tied to COVID vaccine procedures were also added.
New codes to handle remote therapeutic monitoring were added:
- 98975
- 98976
- 98977
- 98980
- 98981
Plus, new codes for principal care management were included:
- 99424
- 99425
- 99426
- 99427
These codes will allow providers to report care management services for patients with chronic conditions, such as lower back pain, in an effort to improve monitoring these complex health problems.
Top 4 Essential Acupuncture Billing Codes
The bulk of the services you will bill to insurance will likely fall under four essential acupuncture CPT codes. Since acupuncture services are always billed in 15-minute increments, your practice will use one code for the initial 15 minutes of service and then a separate code for additional units of time. Your acupuncture billing codes will only vary if you include electronic stimulation in your treatment.
- 97810 Initial Acupuncture: Initial 15-minute insertion of needles, personal one-on-one contact with the patient. (Do not report in conjunction with 97813; use one or the other.)
- 97811 Subsequent Unit of Acupuncture: Use one unit per each additional 15 minutes of personal one-on-one contact with the patient after the initial 15 minutes, with re-insertion of needles. (May be used in conjunction with either 97810 or 97813)
- 97813 Initial Acupuncture with Electrical Stimulation: Initial 15-minute insertion of needles, personal one-on-one contact with the patient. (Do not report in conjunction with 97810; use one or the other.)
- 97814 Subsequent Unit of Acupuncture with Electrical Stimulation: Use one unit per each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles. (May be used in conjunction with either 97810 or 97813)
Acupuncture Billing Codes for Medicare
January marks the two year anniversary of Medicare expanding their coverage options to include acupuncture for treating chronic lower back pain. CPT codes related to billing Medicare for acupuncture treatments are as follows:
- 97810: Acupuncture, one or more needles, without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
- 97811: Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles
- 97813: Acupuncture, one or more needles, with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
- 97814: Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles
- 20560: Services with needle insertion(s) without injection(s) of 1 or 2 muscle(s)
- 20561: Services with needle insertion(s) without injection(s) of 3 or more muscle(s)
Prices will depend on the region of your holistic practice; look up specific codes based on your location here.
Codes for Patients
Medical billing codes for patients can be broken down into two categories, new and returning patients:
New Patients Billing Codes
Use these acupuncture CPT codes for when your holistic practice receives new patients. As a reminder, a new patient is defined as a patient who hasn’t received professional services from you or another provider of the same specialty who has belonged to your practice within the past three years.
- 99201 Evaluation/Management (Limited): Presenting problems are self-limited or minor: requires a problem-focused history, problem-focused examination, and straightforward medical decision-making; the provider typically spends 10 minutes face-to-face with the patient
- 99202 Evaluation/Management (Expanded): Presenting problems are of low to moderate severity; requires an expanded problem-focused history, an expanded problem-focused examination, and straightforward medical decision-making; the provider typically spends 20 minutes face-to-face with the patient
- 99203 Evaluation/Management (Detailed): Presenting problems are of moderate severity; requires a detailed history, a detailed examination, and medical decision-making of low complexity; the provider typically spends 30 minutes face-to-face with the patient
- 99204 Evaluation/Management (Comprehensive): Presenting problems are of moderate to high severity; requires a comprehensive history, a comprehensive examination, and medical decision-making of moderate complexity; the provider typically spends 45 minutes face-to-face with the patient
Returning Patients Billing Codes
These CPT codes for acupuncture can be used for your established patients. Returning patients are those who have received any professional services from you or another provider of the same specialty who has belonged to your practice within the past three years
- 99211 Evaluation/Management (Minimal): Presenting problems are minimal; the provider typically spends five minutes face-to-face with the patient
- 99212 Evaluation/Management (Limited): Presenting problems are self-limited or minor; requires a problem-focused history, a problem-focused examination, and straightforward decision-making; the provider typically spends 10 minutes face-to-face with the patient
- 99213 Evaluation/Management (Expanded): Presenting problems are of low to moderate severity; requires an expanded problem-focused history, expanded problem-focused examination, and medical decision-making of low complexity; the provider typically spends 15 minutes face-to-face with the patient
- 99214 Evaluation/Management (Detailed): Presenting problem(s) are of moderate to high severity; requires a detailed history, a detailed examination, and medical decision-making of moderate complexity; providers typically spend 25 minutes face-to-face with the patient
Acupuncture CPT Codes for Physical Therapy Treatments
Acupuncture practices use a variety of treatments and modalities to help their patients. These treatments and modalities help strengthen, relax, and heal muscles. Below are a few commonly-used acupuncture CPT codes your practice may encounter.
- 20550 & 20551 Tendon Injection: Single tendon injection for the treatment of fasciitis. Could include multiple injections into a single tendon sheath (CPT code 20550) or the tendon origin (CPT code 20551)
- 20552 & 20553 Muscle Injection(s): Injections involving single or multiple trigger points. Could be used to treat one or two muscles (CPT code 20552) or three or more muscles (CPT code 20553)
- 97010 Heat Therapy: Application of a modality to one or more areas; hot or cold packs
- 97016 Cupping: The use of a vasopneumatic device may be considered reasonable and necessary for the application of pressure to an extremity for the purpose of reducing edema
- 97026 Infrared Therapy: The application of infrared therapy is considered medically necessary for patients requiring the application of superficial heat in conjunction with other procedures or modalities to reduce or decrease pain/produce analgesia or reduce stiffness/tension, myalgia, spasm, or swelling
- 97110 Therapeutic Exercise: One or more areas, every 15 minutes; therapeutic procedures to develop strength and endurance, range of motion, and flexibility with direct (one-on-one) patient contact
- 97112 Neuromuscular Reeducation: Treatments to restore movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities with direct (one-on-one) patient contact
- 97140 Manual Therapy: Techniques such as mobilization and manipulation, manual lymphatic drainage, and manual traction, one or more regions, every 15 minutes with direct (one-on-one) patient contact
- 97124 Massage Therapy: Includes effleurage, petrissage, and/or tapotement (stroking, compression, percussion) with direct (one-on-one) patient contact
- 97530 Kinetic Activities: Use of dynamic activities to improve functional performance, every 15 minutes with direct (one-on-one) patient contact
Improve Your Acupuncture Practice’s Billing Processes and Revenue Cycle Management with HBS!
Documenting and billing the right acupuncture codes for insurance reimbursement can be a time-consuming process. No acupuncture practice wants to spend more time billing and coding than it does treating patients and expanding its practice. That’s where an experienced medical billing company with acupuncture CPT code experience can be an invaluable partner.
The team at Holistic Billing Services understands the unique needs of acupuncture practices and has extensive experience working with acupuncture codes to ensure you’re billing patients and insurance companies correctly. With our help, you can start seeing patients covered by insurance quickly and painlessly, no matter what type of acupuncture services you offer.
To learn more about how Holistic Billing can help streamline your practice and accelerate your revenue cycle management, contact our team today.
Medical billing and coding is a complicated, but necessary, process for both medical and holistic practices looking to be reimbursed for services. However, the world of medical billing processes can become rather complicated very quickly, with people throwing around a lot of technical terms that holistic practices may not be accustomed to hearing or dealing with. If your acupuncture practice plans on accepting insurance, you will need to become familiar with this terminology to maximize your insurance reimbursements and minimize denied claims.
You will frequently hear the following common acupuncture billing terms when dealing with insurance claims or working with an experienced acupuncture billing company like Holistic Billing Services. To ensure a streamlined acupuncture billing experience, keep this list handy in case you ever need to quickly reference unfamiliar acupuncture billing terms!
What is Acupuncture Billing?
Medical billing is the process of healthcare providers submitting claims with insurance companies in order to be reimbursed for their services. This can include anything from treatments, procedures, and testing. The medical billing process is essential for most practices to receive payments.
Acupuncture billing practices are not the same as traditional medical billing and have a different set of requirements. Before billing can be initiated, many holistic practices must first be credentialed with health insurance companies. On top of your holistic practice’s insurance enrollments, the right billing, coding, and SOAP documentation must be used.
Acupuncture billing uses its own unique set of codes. Since acupuncture services are always coded in 15-minute increments, you will use one code for the initial 15 minutes of service and then a separate code for additional units of time. Acupuncture CPT codes will only vary if you include electronic stimulation in your treatment.