Acupuncture Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
This policy defines the maximum time unit of service (UOS) for Acupuncture services for face-to-face contact with the patient, addresses supplies that are included in the Acupuncture services and describes the submission of evaluation and management services in conjunction with Acupuncture services.
All services described in this policy may be subject to additional UnitedHealthcare reimbursement policies including, but not limited to, the Maximum Frequency Per Day Policy, the Supply Policy and the CCI Editing Policy.
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Questions and Answers
Q: When selecting the appropriate code based on the services performed, is it appropriate to use the duration of time the patient is in the exam room even if the provider is not present after the needle insertion to determine the units of service?
A: Acupuncture code selection is based on the service provided in 15 minute increments. The time calculation is determined using face-to-face patient contact only. It would not be appropriate to count time spent away from the patient as part of the code selection and units submitted.
Example of billable time: After needle insertion, the practitioner spent time assisting a nauseous patient who had vomited.
Q: Will UnitedHealthcare allow reimbursement for electrical stimulation when performed on a separate body part from where Acupuncture services are performed.
A: Yes, UnitedHealthcare will allow separate reimbursement if modifiers are appropriately used based on the services performed and the modifier description criteria are met.
Q: May both CPT codes 97810 and 97813 be reported when an Acupuncture treatment was initially started without electrical stimulation and then a new needle was inserted so the treatment could be completed with electrical stimulation?
A: No, only one initial code may be reported per day. In this scenario, CPT code 97810 may be used for the initial 15 minutes without electrical stimulation and CPT code 97814 with electrical stimulation may be reported for the additional face-to-face time.
Q: What services would be included in the initial Acupuncture service that would not be separately billable using an E/M code.
A: The initial Acupuncture service codes include E/M components such as the assessment provided prior to and after the needle insertion, treatment discussion and recommendations, preparation, documentation and home instruction.