UnitedHealthCare recently released new reimbursement policy updates that affect Acupuncture procedures. Here's what you need to know in order to properly submit a claim and get paid.
The new policy updates are being enforced to the code descriptions for Acupuncture services that are reported based on a 15 minute time increments of face to face contact with the patient. These time increments are not the duration of needle placement just the face to face contact with the patient.
CPT code guidelines state that only one CPT code ( 97810,97813) should reported per day.
The new maximum units of acupuncture services allowed per date of service in accordance with code descriptions, Centers for Medicare and Medicaid Services (CMS) guidelines and CMS Medicaid National Correct Coding Initiative (NCCI) established Medically Unlikely Edits values are as follows:
CPT/HCPCS Code Medically Unlikely Edits (MUE) Values
97810 1
97811 3
97813 1
97814 2
S8930 3
Cost of needles does not need to be submitted in addition to the service, it is now included in the Acupuncture service. Electrical stimulation services no longer need to be reported separately in addition to a specific acupuncture service that include electrical stimulation. In cases when an electrical stimulation service is performed distinctly and separate from an acupuncture service then a modifier may be appropriate when documentation supports that the service is not related to the acupuncture.
According to CPT guidelines you can only report an evaluation and management (E/M) service can only be reported in addition to an acupuncture service when a patient’s condition requires a separate identifiable E/M service that is above and beyond the usual per and post service work. In these cases the time that is spent for the E/M service is not included in the UOS for the Acupuncture service when reported.
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For more information head over to United Healthcare Policy information