Bodywork and Acupuncture Billing Codes (CPT and ICD-9)

Acupuncture and Bodywork are often covered by various insurance programs in the United States and elsewhere. Insurance payments may be through direct billing by the practitioner or reimbursement to the patient. For some companies only certain conditions are covered, some require a diagnosis and/or prescription from an MD, some cover a set number of treatments per year, and some do not cover these techniques at all. The information below is general medical billing information particular to the US, including the CPT codes for acupuncture and massage/bodywork along with some commonly used ICD-9 codes.

Note: This information changes often and many insurance companies differ in their handling of acupuncture and bodywork. Please speak with the providers in your area to understand their billing processes and requirements.

CPT Codes

CPT Codes stand for "Current Procedural Terminology." They are used by practitioners to define the types of services they provide to a patient. For CAM related techniques they are generally divided by time increments. Of value, then, is the CPT code modifiers intended to allowing billing for additional and reduced time frames (-59 and -52, respectively). These are added to the end of the CPT codes to account for time discrepancies. This is to avoid appearing as if you are double billing for the same session. For example, 97124 (for 15 minutes of bodywork) and 97124-59 for an additional time period within the same session, or 97124-52 for additional time but less overall than an additional session.

  • General CPT Codes
  • 99201-205: Initial Office Consultation (not treatment)
  • 99211-215: Review Office Consultation (not treatment)
  • Acupuncture CPT Codes
  • 97810: Acupuncture, one or more needles, without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
  • 97811: Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles
  • 97813: Acupuncture, one or more needles, with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
  • 97814: Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles
  • Bodywork/Massage CPT Codes
  • 97010: modality; hot or cold packs- 15 minute increment
  • 97124: massage treatment-15 minute increment
  • 97140: myofascial release, manual therapy- 15 minute increment

ICD-9 Codes

For CAM practitioners you most often bill with the ICD-9 code given by a physician. As acupuncturists and other practitioners cannot legally offer a western diagnosis in most states/cases it is perplexing to be asked to submit a code when a patient may have not see their physician first or at all. In most situations, one of the following codes is sufficient for billing purposes.

  • 307.81: Headaches, tension
  • 715.9: Osteoarthritis
  • 719.41: Shoulder Pain
  • 719.42: Elbow Pain
  • 719.43: Wrist Pain
  • 719.45: Hip Pain
  • 719.46: Knee Pain
  • 723.1: Cervicalgia (Neck Pain)
  • 724.2: Lumbar Back Pain
  • 724.5: Back Pain (Unspecified)
  • 719.47: Foot Pain
  • 913.8: Forearm Injury (Unspecified)
  • 959.3: Wrist Injury
  • E812.0: Collision with Motor Vehicle (driver)
  • E812.1: Collision with motor vehicle (passenger)

CAM Billing Resources



Comments

Lorinda Morimoto's picture

I've decided to try to accept

I've decided to try to accept insurance payments in my practice and find that the process of getting accepted as an acupuncture provider by insurance companies is daunting.  For one thing they require much more liability coverage than I currently have.  Are there any services out there that can help walk me through this process?