Why Are My Acupuncture Visits Exceeding 45 Minutes Getting Denied?

Typically, commercial insurance companies peg their reimbursement rates and procedure protocols to the Centers for Medicare and Medicaid Services' (CMS) published guidelines. It is common to find language in insurance contracts expressing reimbursement rates as a multiple or percentage of a CMS fee schedule. Historically, the coding guidelines and pricing did not affect the average acupuncture practitioner as CMS did not recognize the most frequently used acupuncture codes.

However, on Tuesday, January 21st, 2020, CMS announced their decision to cover acupuncture for chronic low back pain, defined as localized pain in the lower back that persists for more than three months.

CPT Codes and Associated Fee Schedules

Here are the CPT code, fee schedule, and max units for some of the most common acupuncture billing codes:

MUE

Additional CMS Updates for Acupuncture Practices

Along with the announcement that acupuncture will now be covered for chronic low pain, CMS provided pricing and usage guidance for acupuncturists. As commercial payers and Veterans Affairs (Triwest and Optum) update their systems, many will follow the new pricing and Medically Unlikely Edits (MUE) values for acupuncture codes.

Reduce Claims Denials in Your Acupuncture Practice with Holistic Billing!

Due to these changes, insurance companies may start denying claims with acupuncture visits exceeding 45 minutes. If your insurance payer is adopting these policies, please ensure you're adhering to these new billing requirements to avoid these denials.

If you need assistance meeting billing requirements, turn to Holistic Billing Services! With our help, you can start seeing patients covered by insurance quickly and painlessly, no matter what type of acupuncture services you offer. After you’ve successfully enrolled in our easy-to-access portal for health insurance billing, you’re ready to get started generating revenue for your acupuncture services! Just send us the details of the treatment you’ve provided and our acupuncture billing experts take care of the rest.

Have additional questions about medical credentialing for holistic practices, EHR, or medical billing for your acupuncture practice? Reach out to one of our experts today!

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As acupuncture insurance billing experts, we've been getting numerous questions from acupuncture providers reporting claim denials for 60-minute visits that used to pay without issues. Read on for our answer to this recently asked question!