Acupuncture services are increasingly being covered by major insurance providers, including Medicare for specific conditions such as chronic low back pain. However, accurate billing is critical for successful reimbursement. Understanding the most common acupuncture CPT codes, proper documentation, and payer-specific guidelines helps healthcare providers avoid denials and revenue leakage.
At Allzone, we specialize in chiropractic and acupuncture billing, ensuring clean claims, accurate coding, and maximum reimbursement. In this blog, we’ll explore the most widely used acupuncture CPT codes and how you can use them effectively in billing.
Why Accurate Acupuncture CPT Coding Matters
Incorrect CPT coding is one of the leading causes of claim denials and underpayments in acupuncture billing. Proper coding helps in:
- Ensuring timely reimbursement
- Reducing claim rejections and denials
- Meeting compliance and payer policies
- Improving practice revenue cycle efficiency
Most Common Acupuncture CPT Codes Explained
Below are the four primary acupuncture CPT codes used in insurance billing:
97810 – Initial Acupuncture Without Electrical Stimulation
- Description: Initial 15 minutes of personal, one-on-one contact with the patient.
- Use: First code billed for a new session without any electrical stimulation.
- Important Note: This code can only be billed once per session.
97811 – Subsequent Acupuncture Without Electrical Stimulation
- Description: Each additional 15-minute increment of one-on-one acupuncture.
- Use: Used after 97810 when additional time is spent.
- Requires: The service must be in increments of a minimum 8 minutes.
97813 – Initial Acupuncture With Electrical Stimulation
- Description: Initial 15 minutes of acupuncture using electrical stimulation.
- Use: The first code used when electrical stimulation is applied from the start.
- Rule: Can be billed only once per session.
97814 – Subsequent Acupuncture With Electrical Stimulation
- Description: Additional 15-minute increments with electrical stimulation.
- Use: Used after 97813 in units of at least 8 minutes each.
Acupuncture CPT Coding Time Rules (Medicare 8-Minute Rule)
| Time Spent (Minutes) | Billable Units |
| 8 – 22 mins | 1 unit |
| 23 – 37 mins | 2 units |
| 38 – 52 mins | 3 units |
| 53 – 67 mins | 4 units |
Only time spent with direct, face-to-face contact qualifies for unit billing.
Modifiers Used with Acupuncture CPT Codes
| Modifier | Description | When to Use |
| GP | Services under a therapy plan of care | For Medicare billing |
| 25 | Significant, separately identifiable E/M service | If E/M provided same day |
| 59 | Distinct procedural service | Used for multiple procedures when needed |
Medicare Coverage for Acupuncture Services
Medicare Part B covers acupuncture only for chronic low back pain when:
- Pain lasts 12 weeks or longer
- There is no known cause such as cancer or inflammatory disease
- Services are provided by a licensed practitioner
Medicare coverage limits:
- Up to 12 sessions in 90 days
- 8 additional sessions approved if improvement is documented
- Maximum of 20 sessions per year
Allzone ensures compliance with Medicare policies to reduce denials and documentation issues.
Documentation Requirements for Acupuncture Billing
Proper documentation plays a crucial role in validating medical necessity. Ensure the following are included:
- Diagnosis code supporting the need for treatment
- Treatment area(s) and method used
- Session duration and face-to-face time
- Patient progress and response to therapy
- Use of electrical stimulation, if applicable
Common Denial Reasons in Acupuncture Billing
| Issue | Cause | Prevention Strategy |
| Missing time documentation | No face-to-face minutes listed | Log direct patient time |
| Wrong primary code used | 97811 or 97814 billed first | Always start with 97810 or 97813 |
| Missing modifier | GP modifier not used for Medicare | Add appropriate modifiers |
| Lack of medical necessity | No supporting diagnosis | Use ICD-10 codes that justify pain |
With Allzone’s denial management services, we help your practice eliminate repeat denials and recover lost revenue.
ICD-10 Codes Often Used with Acupuncture CPT Codes
| ICD-10 Code | Description |
| M54.50 | Chronic low back pain |
| M79.10 | Myalgia, unspecified site |
| R51.9 | Headache, unspecified |
| M25.561 | Chronic pain in right knee |
| G44.1 | Vascular headache |
Always match diagnosis codes with payer-specific covered conditions.
Best Practices for Successful Acupuncture Medical Billing
- Always document time-based services accurately.
- Assign correct CPT codes for initial and subsequent units.
- Use modifiers correctly for Medicare and insurance claims.
- Validate medical necessity with supporting ICD-10 codes.
- Outsource to a specialized RCM partner like Allzone
Why Choose Allzone for Acupuncture Billing Services?
At Allzone Management Services, we offer specialized billing and coding support for acupuncture providers. Our expertise ensures:
- Clean claim submission
- Compliance-driven coding accuracy
- Improved reimbursement rates
- Transparent RCM reporting
- Low denial rate
- Timely follow-up and appeals
Whether you’re an independent practitioner or a multi-location practice, we streamline your entire billing cycle to improve revenue outcomes.