If you are an acupuncturist, you already know code 97810. Procedure code CPT-4 97810 is a general code for acupuncture treatment. This includes 15 minutes of time checked with the patient during the course of treatment. Checked time means that time increments are documented in the patient record for the correct service date.
97811 is used every additional 15 minutes dedicated to administering the treatment. This does not include the time the patient spends idle at the table. For example, if a frontal treatment is performed without any other services, 97810 will be charged. However, if the patient receives frontal and subsequent treatment, 97810 and 97811 should be used.
Now that we have explained the meaning of procedural codes 97810 and 97811, we can begin to look at the top 2 reasons insurers do not reimburse you.
Claim Submitted to Medicaid or Medicare
Neither Medicaid nor Medicare will pay for acupuncture insurance. Medicaid and Medicare are suitable insurance policies for young people, the poor, the sick and the elderly; however, insurance policies do not insure everything. Medicare decides the medical need when they get the claim. Meanwhile, Medicare has no consideration for holistic medicine, acupuncture, alternative therapies, and homeopathy as necessary medical procedures. Therefore, acupuncture requests will not be paid. If your Medicaid or Medicare insurance policy does not insure acupuncture, you are going to be liable to pay the entire fees if you obtain these services. Many acupuncturists voluntarily discount their prices for uninsured patients. To learn more about Medicare Advantage plans click here.
Medicare also offers supplemental plans, allowing someone to get coverage where there was none before. Medicare benefit plans may offer acupuncture and alternative therapies. Although Medicare benefit plans cover acupuncture, the service will only be paid if it is considered clinically necessary and if the services are provided by a licensed Medicare healthcare professional. To know whether your Medicare patients have insurance for acupuncture, perform the Benefit Check. A competent and experienced medical professional should know whether or not a claim will be paid before it is forwarded to the insurance company. A thorough and documented benefit check will provide the information you need to make this determination at all times.
Incorrect procedure code
There are four codes that are widely used by the acupuncturist. We have discussed two of these codes already, viz, 97811 and 97810. There are however, 2 additional codes, which are 97813 & 97814. The 97813 is utilized when the acupuncturist makes use of electrical stimulation on at least one or more needles. Remember, this is only for the first 15 minutes devoted to performing the procedure. 97814 is used every additional 15 minutes used using electrical stimulation on one or more needles. Often licensed acupuncturists simply code the procedures incorrectly.