The international medical community recognizes acupuncture as a proven alternative therapeutic practice.

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FROM NEEDLES TO NUMBERS: MASTERING ACUPUNCTURE BILLING

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FROM NEEDLES TO NUMBERS: MASTERING ACUPUNCTURE BILLING
The international medical community recognizes acupuncture as a proven alternative therapeutic practice.
The transition from providing therapeutic services to receiving remuneration payments involves multiple
complex hurdles. In fact, acupuncturists require complete knowledge of medical billing criteria to establish
functional practices and maintain monetary success and regulatory compliance.
This blog explains essential acupuncture billing principles through an extensive study of CPT codes,
accurate modifier application, ideal documentation procedures, and insurance verification practices.
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to-numbers-mastering-acupuncture-billing
Decoding Acupuncture CPT Codes
The health sector uses Current Procedural Terminology (CPT) codes as the global language through
which healthcare providers exchange information with payment partners. Acupuncture practitioners
calculate their charges based on particular CPT codes which indicate both treatment duration and types of
procedures together with added services for sessions.
The following are CPT codes for charging acupuncture:
97810 – The code covers fifteen minutes of acupuncture treatment without electrical stimulation in its
initial phase. It includes needle insertion and personal one-on-one patient interaction.
97811 – This is assigned for every 15 minutes of acupuncture with no electrical stimulation, including
insertion of needles reinsertion.

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Role of Modifiers in Acupuncture Billing
Medical billing requires modifiers as they provide supplemental details concerning the
performed work. Proper implementation of modifiers within acupuncture billing solutions
helps protect reimbursement payments and reduces the chances of denied claims.
Some of the most common modifiers applied in acupuncture billing are:
Modifier 25 – An important Evaluation and Management (E/M) service that requires separate
billing that occurred on the date of acupuncture treatment.
Modifier 59 – The modifier indicates a separate performance of two distinct procedures that
occurred within a single visit. Using this modifier enables practitioners to protect the
independent billing of treatments when they combine manual therapy with acupuncture.
Modifier GP – Healthcare providers use this code to report acupuncture services when the
treatment falls within established physical therapy guidelines according to CMS guidelines for
acupuncture billing.
Using these modifiers correctly ensures that claims accurately reflect all patient
treatment for proper reimbursement.
FROM NEEDLES TO NUMBERS: MASTERING ACUPUNCTURE BILLING

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Documentation Requirements
Precise and accurate documentation stands as the core requirement for billing acupuncture successfully. The
documentation serves to validate claims while functioning as useful proof during auditing procedures.
Well-documented treatment sessions for acupuncture should include the following
information:
Patient Identification: Demographic data and full insurance documentation must be complete in order to
make proper insurance claims.
Diagnosis Codes: Healthcare providers must enter ICD-10-CM codes in the medical records to
demonstrate that acupuncture is medically necessary.
Treatment Plan: The treatment plan needs to provide detailed information about the established
objectives with specified number of sessions and expected outcomes.
Service Details: The record should include procedures for documenting treatment duration, needle
counts, and electrical stimulation methods.
Provider Notes: The medical notes should indicate patient improvements, treatment responses, and
changes to the care plan.
Consent Forms: The legal and insurance requirements dictate patients approve their treatment by
signing consent forms prior to receiving acupuncture healthcare.
Keeping accurate and complete records will expedite the claims process and prevent
FROM NEEDLES TO NUMBERS: MASTERING ACUPUNCTURE BILLING

5. 2025 SUD BILLING PREDICTIONS: ADAPTING TO NEW REIMBURSEMENT MODELS
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Overcoming Acupuncture Billing Common Challenges
Despite its benefits, acupuncture billing comes with several challenges. Here are some of the
typical issues faced by acupuncture practitioners with the ways to overcome them:
Incorrect Use of Codes: The billing staff should receive regular training about CPT code
updates and payer rules to prevent claim rejection.
Lack of Documentation: Templates with pre-filled documentation ensure complete
documentation of essential information.
Incorrect Application of Modifiers: The regular hosting of application training sessions
regarding modifier implementation will minimize mistakes.
Differences in Insurance Coverage: The process of verifying patient insurance benefits prior
to therapy assists practitioners in understanding their coverage boundaries and procedures.
Acute attention to these problems will decrease denied claims for acupuncture practitioners
while improving their revenue cycle effectiveness.

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MODELS
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Conclusion
Acupuncture billing is crucial in bridging the gap between patient holistic treatment and cost-
effectiveness. By acquiring knowledge of how to utilize CPT codes effectively, utilize modifiers
appropriately, and document effectively, the practitioner will be able to obtain maximum
reimbursement as well as minimize the inefficiency of the practice. Further, staying current
with trends and outsourcing to a best acupuncture billing services provider company such as
24/7 Medical Billing Services can significantly simplify billing.
Whether you're a solo practitioner or operating a multi-provider clinic, understanding the
intricacies of acupuncture billing is essential to the success of your practice. With accuracy,
meticulous care, and the right equipment, you can conquer the intricacies of medical billing—
ensuring your patients' health as well as the success of your practice.

7. 2025 SUD BILLING PREDICTIONS: ADAPTING TO NEW REIMBURSEMENT MODELS
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Insurance Verification and Pre-Authorization Responsibilities
Insurance verification is the first and foremost step toward achieving a smooth revenue cycle management
(RCM). Before providing acupuncture treatment, practitioners need to verify the following information with the
insurance provider:
Is acupuncture covered under the patient's plan? Different insurance plans cover acupuncture procedures
differently.
Are there any limitations on visits? Some policies put restrictions on the number of acupuncture visits annually.
Is pre-authorization required? Certain insurance policies require pre-authorization before they will accept
acupuncture services.
Are there specific modifiers or forms of documentation required? Being aware of the particular insurer
requirements can prevent denied claims.
Pre-authorization, when required, prevents practitioners from assuming the risk of denied claims and allows for
improved reimbursement processes.

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About 24/7 Medical Billing Services:
24/7 Medical Billing Services is the nation’s leading medical billing service provider
catering services to more than 42 specialties across the entire 50 states. You can rely
on us for end-to-end revenue cycle management. We guarantee up to 10-20%
increase in the revenue with cost reduction of your practice for up to 50%.
Call us today at 888-502-0537 to know more on how we can help boost profitability
for your practice.
Media Contact:
24/7 Medical Billing Services,
Georgia:
3001 Greenfield Drive, Marietta GA, 30068
Texas:
2028 E Ben White Blvd, #240-1030 Austin TX, 78741
Tel: + 1 -888-502-0537
Email - info@247medicalbillingservices.com
2025 SUD BILLING PREDICTIONS: ADAPTING TO NEW REIMBURSEMENT MODELS