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 correctly. 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, such as evaluating the patient. The period that the code relates to is between needle placement and removal. CPT 97811 is for an additional 15 minutes. In 30 min, altogether, you consume 97810 + 97811 once. Spending 45 minutes, one adds 97811 twice. 

Credex Healthcare has training in these codes. They also instruct on how to identify the right time blocks. They demonstrate how to put time into your books. They also give some explanations on the use of modifiers. Modifiers can inform payers about how you treated more than one area or separate visits. 

The appropriate manual acupuncture billing codes are time-saving. It also reduces errors. Billing groups that abide by the regulations experience fewer reimbursements. They get paid faster. They make sure that all minutes of care are recorded. 

CPT Codes for Electroacupuncture: 97813 & 97814 

The initial 15 minutes of electroacupuncture are included in the electroacupuncture billing code 97813. You prepare the needles and place them on a small electric thing. You select a frequency and run it. The code encompasses the session. Every 15 minutes, more than the first are charged CPT 97814. You multiply by 97814/additional quarter hours. 

Such codes are more recent than the manual ones, and therefore, some payers demand additional evidence. In your documentation, you need to record the length of time the device was running and the settings. There should be a definite course of treatment and CPT entry. To record time, frequency, and device information, templates are supplied by Credex Healthcare. Additional revenue will be possible when you utilize the electroacupuncture codes because some payers will pay higher when you use the codes. One should verify CMS acupuncture payment policies and the policies of individual payers. Credex Healthcare records every update to ensure that you do not miss any changes. 

Medicare Guidelines for Acupuncture Billing 

Medicare acupuncture billing includes tight guidelines. Acupuncture is covered under Medicare due to chronic low back pain. You should possess a full course of treatment and a signed document as to why you need acupuncture. Other therapies that include physical therapy or painkillers should be tried before you resort to surgery. You will have up to a maximum of 12 sessions in 90 days. 

Credex Healthcare can assist you in adhering to these by drawing you through the CMS guidelines and the Medicare policy on acupuncture. They demonstrate how to bill evaluation and management (E/M) in the case of an exam taken on the same day and how to combine codes properly. 

SOAP notes and time logs may be needed in Medicare. SOAP notes consist of Subjective, Objective, Assessment, and Plan. The time logs should include the time that a code begins and ends. When you do manually and electroacupuncture, do them on the same day, you should include each code and the time. Do not bill twice for the same minutes. 

Required Documentation & Time-Based Coding 

Correct acupuncture billing begins with knowledge of the CPT codes that include the manual and electroacupuncture procedures. Correct codes together with adequate documentation and time tracking will assure full compliance, and maximize reimbursement, particularly with the fact that the policies of coverage, especially Medicare and commercial insurance, are periodically updated. 

This should be captured in your notes in terms of the time taken on each code. Assuming you use 97810 and 97811, enter 15 minutes on the first code and 15 minutes on each extra code. Record the device time, should you use 97813 and 97814. Note the insertion and removal of needles also. Sign every page of the record, and retain all records for a minimum of six years. 

The Credex Healthcare offers electronic health record (EHR) templates that are used to direct acupuncturists in filling out SOAP notes. These templates are used to allow coders to see what does not exist and guide billers in using the right code on each note. They assist in minimizing mistakes and denials in claims. 

Billing Acupuncture with Evaluation and Management (E/M) 

You can charge E/M codes along with acupuncture when you do an exam or a counseling session on the same visit. Some payers permit this on a separate face-to-face visit. You will have to record the medical necessity of such a visit. You have to mark the exam particulars. You have to insert modifier 25 on the E/M code. 

Credex Healthcare educates you to code E/M and acupuncture CPT together. They will teach you how to write concise notes and E/M levels to take in simple and complex exams. They also help you avoid E/M audits. 

Combining two codes will increase your income only when you satisfy payer requirements. Some payers do not cover E/M when it is performed on the same day. You should verify the policy of every payer. In the record, you will have to demonstrate clear services. Credex Healthcare monitors commercial payer updates to ensure that you are aware of the insurers that allow you to bill both. 

Tips to Avoid Claim Denials 

To prevent rejection, provide information on properly used CPT code at each stage. Make sure to check the coverage of the patient prior to visitation. Check acupuncture and E/M benefits. 

Use the exact listed enter codes. Guess not at minutes or device settings. Take advantage of the time-based CPT coding in acupuncture in your EHR. Keep notes clear and dated. Enter one code in a line. Do not lump disparate services into a single code. 

Credex Healthcare provides denial prevention manuals. They present you with billing guidelines for electroacupuncture that are within payer requirements. Additionally, they report case studies of offices that reduced half of the denials. Lastly, they educate your staff about reading remittance advice and correcting mistakes in a short time. 

Final Thoughts 

Acupuncture billing codes are essential to clinic success. With the right acupuncture billing codes and following the acupuncture documentation requirements, you get proper payment. Credex Healthcare is prepared to lead you. They train the acupuncture policy of Medicare and the connection between E/M and acupuncture. They provide templates, tools, and real-time payer updates. 

Staying updated on acupuncture CPT codes in 2025 will ensure your revenue is robust, your office compliant, and you can continue treating patients. Relax, Trust Credex Healthcare will assist you with your coding, billing, and documentation. Your acupuncture reimbursement can be mastered with clear notes, correct codes, and powerful systems, thus expanding your practice. 

FAQs   

Which is the right CPT code for manual acupuncture? 

The proper CPT code for the initial 15 minutes of manual acupuncture is 97810. For each extra 15 minutes, use 97811. 

Does Medicare pay for acupuncture services? 

Medicare covers acupuncture in chronic cases of lower back pain. You require a treatment plan, SOAP notes, and to abide by CMS acupuncture coverage requirements. 

What is the charge for electroacupuncture? 

Bill the first 15 min less than 97813 and every 15 min less than 97814. You have to record device settings and run time. 

What are the acupuncture billing documentation requirements? 

You require the SOAP notes, time sheets, signed treatment plans, and patient consent. You should have proper entries of the start and end times of each code. 

Do you bill E/M codes under acupuncture CPT codes? 

Yes. In case you conduct a separate face-to-face examination, it is an E/M code with a modifier 25. You have to record separate services.