Coverage is expanding fast
Insurance coverage for acupuncture has expanded significantly in recent years. Many commercial plans, Medicare Advantage plans, and state Medicaid programs now include acupuncture benefits for specific conditions. That is great news for patients and for your practice - but only if you can navigate the billing process without losing time and money to claim denials.
Know your CPT codes
The foundation of acupuncture billing is a small set of CPT codes that you will use for nearly every visit. The most common are:
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 acupuncture without electrical stimulation, used alongside 97810.
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 acupuncture with electrical stimulation, used alongside 97813.
You can bill the initial code (97810 or 97813) once per session, and the add-on codes (97811 or 97814) for each additional 15-minute increment. Do not mix electrical and non-electrical codes in the same session. Pair these with the appropriate ICD-10 diagnosis codes that support medical necessity.
Create a clean superbill
A superbill is the document you give patients - or submit to insurers - that summarizes the visit. It should include your NPI number, the patient's information, date of service, diagnosis codes, CPT codes, and fees. A well-structured superbill reduces back-and-forth with insurance companies and speeds up reimbursement.
If you bill patients directly and they submit for reimbursement themselves, a clear superbill makes that process much easier for them. This small courtesy improves the patient experience and reduces the number of questions you field after each visit.
Verify eligibility before the first visit
One of the most common billing pitfalls is treating a patient without confirming their acupuncture coverage first. Benefits vary widely between plans - some cover a limited number of visits per year, some restrict coverage to specific diagnoses, and some require pre-authorization.
Run an eligibility check before the patient's first appointment. This tells you whether acupuncture is covered, how many visits remain, whether a referral is required, and what the patient's copay or coinsurance will be. Stillpoint supports eligibility verification so you can check coverage without calling the payer directly.
Avoid common pitfalls
Underdocumentation is the leading cause of claim denials. Your notes must clearly support the medical necessity of each treatment. Include the diagnosis, treatment rationale, points used, and the patient's response. See our guide on documenting acupuncture treatments for best practices.
Timely filing deadlines vary by payer but are typically 90 to 180 days from the date of service. Miss the window and the claim will not be paid, regardless of its merit.
Incorrect modifier usage can also trigger denials. If you are billing for services provided by an associate or under supervision, make sure the appropriate modifiers are applied.
Build billing into your workflow
Billing should not be something you batch at the end of the week. The most efficient practices generate claims as part of their visit workflow - finish the note, confirm the codes, and submit or save the superbill before the next patient arrives. When billing is built into your daily rhythm, errors drop and cash flow improves.
If insurance billing has felt like a barrier to growing your practice, the right tools can make it manageable. Create a free Stillpoint account and start bringing billing, scheduling, and documentation into one streamlined workflow.