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Billing for multiple units of acupuncture services
November 25, 2019

This article is for acupuncturists caring for our members

To ensure that your claims for our indemnity, PPO (including Federal Employee Program), and HMO members process correctly, we’d like to provide you with some examples on how to bill claims for codes in which you may bill multiple units. Incorrect billing may result in claims rejecting as duplicate services.

Example: You are providing one hour of acupuncture using the following CPT codes:

  • CPT 97813: Acupuncture, one or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
  • CPT 97814: Acupuncture, one or more needles; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (list separately in addition to code for primary procedure)

You should bill as follows:
On the first row, bill one unit of 97813
On the second row, bill three units of 97814

Do not bill CPT 97814 on three separate rows of one unit each. This will result in the rejection of two units CPT 97814 because our system will see these as duplicate services.

Example: You are providing one hour of therapeutic procedures using the following CPT code:

  • CPT 97110: Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility

You should bill as follows:
On the first row, bill four units of 97110.

Do not bill four separate rows of one unit each. This will result in the rejection of three units of CPT 97110 because our system will see these duplicate services.

MPC_111919-1G-1-ART

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