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1. #BLUE CROSS BLUE SHIELD COPAY MEDICAL CODE 99211 MANUAL#
2. #BLUE CROSS BLUE SHIELD COPAY MEDICAL CODE 99211 PROFESSIONAL#

** Precious metal needles (e.g., gold, silver, etc.) ** **cupuncture when used as an anesthetic during a surgical procedure ** **djunctive therapies, such as but not limited to moxibustion, herbs, oriental massage, etc. ** **cupuncture with electrical stimulation

#BLUE CROSS BLUE SHIELD COPAY MEDICAL CODE 99211 PROFESSIONAL#

According to CPT guidelines, a new patient is one who has not received any professional services from the physician within the past three years. Acupuncture assistants are not recognized for separate reimbursement and are therefore considered inclusive of the acupuncture reimbursement.Īn initial evaluation (99201-99205) is allowed only for new patients. Ac.) or physician (State of Rhode Island-licensed MD or DO)* only. Auxiliary personnel furnishing acupuncture must be under the appropriate level of supervision of a physician, PA, or NP/CNS required by our regulations at 42 CFR §§ 410.26 and 410.27.Īcupuncture and an initial evaluation (for a new patient) is covered when rendered by a licensed doctor of acupuncture (D.The following procedure code ranges will deny for chiropractors as non-covered services:

#BLUE CROSS BLUE SHIELD COPAY MEDICAL CODE 99211 MANUAL#

Chiropractors are not limited to any specific procedures and may render services as they feel necessary, but according to CMS guidelines the benefit will only cover manual spinal manipulation, which includes procedure codes: 98940, 98941, and 98942. All other services furnished or ordered by chiropractors are not covered. When a separate E/M service is reported, the time spent for the E/M service is not to be included in the time UOS for the Acupuncture serviceĬovered Services for Medicare Advantage Members:Īccording to the Centers for Medicare & Medicaid Services (CMS) Internet-only manual, Publication 100-02 Medicare Benefit Policy Manual, chapter 15, section 30.5, chiropractors’ services extend only to treatment by means of manual manipulation of the spine to correct a subluxation. Per CPT guidelines an evaluation and management (E/M) service may only be reported in addition to Acupuncture services if the patient’s condition requires a significant, separately identifiable E/M service above and beyond the usual pre-service and post-service work associated with the Acupuncture service. A modifier may be appropriate when an electrical stimulation service is performed distinctly and separate from the Acupuncture service and the documentation supports the service was not related to the Acupuncture. The CMS National Physician Fee Schedule (NPFS) indicates these supplies are part of the Practice Expense (PE) and should not be reported separately.Ĭonsistent with the CPT code description and the CMS NCCI Procedure to Procedure Coding Edits (PTP), electrical stimulation services (97014, 97032 and G0283) should not be reported separately in addition to specific Acupuncture services that include electrical stimulation (97813, 97814 and S8930). The cost of needles (A4212 and A4215) is included in the Acupuncture service and will be denied if submitted in addition to the Acupuncture service. In addition, CPT® code guidelines state only one initial CPT code, 97810 or 97813, should be reported per day.

This policy enforces the code description for Acupuncture services which are to be reported based on 15 minute time increments of personal face-to-face contact with the patient and not the duration of the needle(s) placement. The FEP does not include benefits for acupuncture when performed by a chiropractor.Īcupunctures CPT code and fee schedules Insurance Only one initial code is reported per day. Use either 97810 or 97813 for the initial 15 minute increment. Only one code may be reported for each 15 minute increment. If electrical stimulation of any needle is used during a 15 minute increment, use 97813 or 97814. If no electrical stimulation is used during a 15 minute increment, use 97810 or 97811. Acupuncture is reported based on 15 minute increments of personal (face-to-face) contact with the patient, not the duration of acupuncture needle(s) placement.