When billing insurance for acupuncture many providers miss out on significant reimbursements by not billing evaluation and management codes (E&M). In many states acupuncturists are eligible to bill for E&M codes. As an acupuncture billing company we come across far too many providers not billing E&Ms due to a lack of understanding of the codes and how they are used in acupuncture billing. If you are holding back on billing E&Ms here is some information to get you familiar with the codes:
New Patient
Billing a new patient visit code the 1st time you see a patient is proper using codes 99201-99205. A new patient is someone who has not received any professional services from you or another provider of the same specialty who belongs to your group practice, within the past three years.
| CODE | DESCRIPTION |
| 99201 | Evaluation/Management ”“ Limited |
| Presenting problem(s) are self-limited or minor; requires a problem focused history, problem-focused examination and straightforward medical decision-making. Providers typically spend 10 minutes face-to-face with patient and/or family. | |
| 99202 | Evaluation/Management ”“ Expanded |
| Presenting problem(s) are low to moderate severity; requires an expanded problem focused history, an expanded problem-focused examination and straightforward medical decision-making. Providers typically spend 20 minutes face-to-face with patient and/or family. | |
| 99203 | Evaluation/Management ”“ Detailed |
| Presenting problem(s) are of moderate severity; requires a detailed history, a detailed examination and medical decision-making of low complexity. Providers typically spend 30 minutes face-to-face with patient and/or family. | |
| 99204 | Evaluation/Management ”“ Comprehensive |
| Presenting problem(s) are of moderate to high severity; requires a comprehensive history, a comprehensive examination and medical decision-making of moderate complexity. Providers typically spend 45 minutes face-to-face with patient and/or family. | |
| 99205 | Evaluation/Management ”“ Complex |
| Presenting problem(s) are of moderate to high severity; requires a comprehensive history, a comprehensive examination and medical decision-making of high complexity. Providers typically spend 60 minutes face-to-face with patient and/or family. |
Established Patient
An established patient is one who has received any professional services from you or another provider of the same specialty who belongs to your group practice, within the past three years. It is inappropriate to bill an established patient visit (Codes 99211-99215) on every visit as your usual acupuncture treatment codes already have a day to day evaluation component to assess the progress of your patient.
| CODE | DESCRIPTION |
| 99211 | Evaluation/Management ”“ Minimal |
| Presenting problem(s) are minimal. Typically 5 minutes are spent performing or supervising these services. | |
| 99212 | Evaluation/Management ”“ Limited |
| Presenting problem(s) are self-limited or minor; requires a problem-focused history, a problem-focused examination and straightforward decision-making. Providers typically spend 10 minutes face-to-face with the patient. | |
| 99213 | Evaluation/Management ”“ Expanded |
| Presenting problem(s) are of low to moderate severity; requires an expanded problem-focused history, and expanded problem-focused examination and medical decision-making of low complexity. Providers typically spend 15 minutes face-to-face with the patient. | |
| 99214 | Evaluation/Management ”“ Detailed |
| Presenting problem(s) are of moderate to high severity; requires a detailed history, a detailed examination and medical decision-making of moderate complexity. Providers typically spend 25 minutes face-to-face with the patient and/or family. | |
| 99215 | Evaluation/Management ”“ Comprehensive |
| Presenting problem(s) are of moderate to high severity; requires a comprehensive history, a comprehensive examination and medical decision making of high complexity. Providers typically spend 40 minutes face-to-face with the patient and/or family. |