Acupuncture CPT Codes 2025: Billing Guidelines & Tips

What Are CPT Codes for Acupuncture?

CPT codes for acupuncture are a set of numbers that tell payers what service was given. Acupuncturists use these codes to bill insurance. The main codes are 97810 and 97811 for manual acupuncture. They also use 97813 and 97814 for electroacupuncture. Each code covers a session of needling. The codes help payers like Medicare, Aetna, and Cigna know what care was given. Credex Healthcare guides you to use these codes right. They help acupuncturists, coders, and billers learn the rules.

Every practice needs to follow acupuncture coding guidelines. These guidelines tell you how to pick the right code. You must match each code to the service time. You must also meet payer rules. Using the correct code keeps claims from being denied. It also makes sure you get paid the right amount.

CPT Codes for Manual Acupuncture: 97810 & 97811

CPT 97810 is for the first 15 minutes of manual acupuncture. You use this code when you place needles and let them sit. You also do other work like evaluating the patient. The code covers the time from needle placement to removal. CPT 97811 is for each extra 15 minutes. If you spend 30 minutes in total, you use 97810 plus 97811 once. If you spend 45 minutes, you add 97811 twice.

Credex Healthcare trains billing teams on these codes. They teach you how to spot the right time blocks. They show you how to log the time in your records. They also explain when to add modifiers. Modifiers may tell payers that you treated more than one area or did separate visits.

Using the right manual acupuncture billing codes saves time. It also reduces errors. Billing teams that follow the rules see fewer denials. They get paid faster. They make sure that every minute of care is captured.

CPT Codes for Electroacupuncture: 97813 & 97814

Electroacupuncture billing code 97813 covers the first 15 minutes of electroacupuncture. You set up the needles and attach them to a small electric device. You select a frequency and let it run. The code covers the full session. CPT 97814 is for each additional 15 minutes beyond the first block. You add 97814 for each extra quarter hour.

These codes are newer than manual ones. That means some payers need extra proof. You must show in your notes how long the device ran. You must also note the settings. You need a clear treatment plan CPT entry in your records. Credex Healthcare offers templates for these plans. They help you document time, frequency, and device details.

Using electroacupuncture codes can boost your revenue. Some payers pay more for this service. You must check CMS acupuncture coverage rules. You must also check private payer policies. Credex Healthcare tracks all updates so you do not miss a change.

Medicare Guidelines for Acupuncture Billing

Medicare acupuncture billing has strict rules. Medicare covers acupuncture for chronic low back pain. You must have a full treatment plan. You need a signed document that says why acupuncture is needed. You must try other treatments first, like physical therapy or pain meds. You must treat no more than 12 sessions in 90 days.

Credex Healthcare helps you follow these rules. They guide you on CMS guidelines and Medicare’s acupuncture policy. They show you how to code evaluation and management (E/M) if you do an exam on the same day. They teach you how to combine codes correctly.

Medicare may ask for SOAP notes and time logs. SOAP notes stand for Subjective, Objective, Assessment, and Plan. Time logs must show start and end times for each code. If you do manual acupuncture and electroacupuncture on one day, you must list each code with its time. You must not double bill the same minutes.

Required Documentation & Time-Based Coding

Accurate acupuncture billing begins with understanding the CPT codes that represent both manual and electroacupuncture procedures. Using correct codes, along with proper documentation and time tracking, ensures full compliance and optimized reimbursement especially with Medicare and commercial insurers updating coverage policies frequently.

Your notes must show the time you spent on each code. If you use 97810 and 97811, you must log 15 minutes for the first code and 15 minutes for each extra code. If you use 97813 and 97814, you log device time. You also need to note needle insertion and removal. You need to sign each page of the record. You need to keep records for at least six years.

Credex Healthcare offers electronic health record (EHR) templates. They guide acupuncturists on SOAP notes. They help coders spot missing entries. They help billers link each note to the right code. This reduces errors and claim denials.

Billing Acupuncture with Evaluation and Management (E/M)

When you do an exam or counseling in the same visit, you may bill E/M codes with acupuncture. Some payers allow this if you do a separate face-to-face visit. You must document the medical necessity of that visit. You must note the exam details. You must use modifier 25 on the E/M code.

Credex Healthcare shows you how to combine E/M codes with acupuncture CPT codes. They teach you how to write clear notes. They teach you which E/M levels to use for simple exams and for complex ones. They help you avoid E/M audits.

Using both codes can boost your revenue. But only if you meet payer rules. Some payers deny E/M when done on the same day. You must check each payer’s policy. You must show distinct services in the record. Credex Healthcare tracks commercial payer updates so you know which insurers let you bill both.

Tips to Avoid Claim Denials

To avoid denials, use “accurate CPT code usage” at every step. Always check the patient’s coverage before the visit. Verify benefits for acupuncture and E/M. Use clearinghouses like Availity or Waystar to see coverage in real time.

Enter codes exactly as listed. Do not guess on minutes or device settings. Use “time-based CPT coding in acupuncture” methods in your EHR. Keep notes clear and dated. Use a separate line for each code. Do not bundle different services under one code.

Credex Healthcare offers denial prevention guides. They show you “electroacupuncture billing guidelines” that meet payer rules. They share case studies of offices that cut denials by half. They teach your team how to read remittance advice and fix errors quickly.

FAQs About Acupuncture Billing Codes

• What is the correct CPT code for manual acupuncture?
  The correct CPT code for the first 15 minutes of manual acupuncture is 97810. For each extra 15 minutes, use 97811.
• Does Medicare cover acupuncture services?
  Medicare covers acupuncture for chronic low back pain. You need a treatment plan, SOAP notes, and to follow CMS acupuncture coverage rules.
• How do you bill for electroacupuncture?
  Bill the first 15 minutes under 97813 and each extra 15 minutes under 97814. You must document device settings and run time.
• What documentation is needed for acupuncture billing?
  You need SOAP notes, time logs, signed treatment plans, and patient consent. You need clear entries for start and end times of each code.
• Can you bill E/M codes with acupuncture CPT codes?
  Yes. If you perform a separate face-to-face exam, you use an E/M code with modifier 25. You must document distinct services.

Final Thoughts

Acupuncture billing codes are key to clinic success. By using the right acupuncture billing codes and following acupuncture documentation requirements, you secure accurate payment. Credex Healthcare stands ready to guide you. They teach “Medicare’s acupuncture policy” and “how to link E/M with acupuncture.” They offer templates, tools, and real-time payer updates.

In 2025, staying on top of acupuncture CPT codes will keep your revenue healthy. It will keep your office compliant. It will let you focus on patient care. Trust Credex Healthcare to support your coding, billing, and documentation. With clear notes, correct codes, and strong systems, you can master acupuncture reimbursement and grow your practice.