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BILLING ISSUES

FREQUENTLY ASKED QUESTIONS

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NEW CPT CODES 2020

20561 3 OR MORE MUSCLES

NEEDLE INSERTION WITHOUT INJECTION

20560 NEEDLE INSERTION(S) WITHOUT INJECTION(S) DESCRIBES DRY NEEDLING TO 1 OR 2 MUSCLES

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DO NOT BILL UNDER ACUPUNCTURE CPT!

97811 AND 97813 ARE RESERVED FOR LICENSED ACUPUNCTURISTS

THE ONE EXCEPTION TO THIS APPEARS TO BE FOR CHIROPRACTORS WHO ARE CERTIFIED IN ACUPUNCTURE. NOTE: MAY REQUIRE

A PHYSICIAN REFERRAL TO BILL MEDICARE

MEDICARE RECENTLY APPROVED ACUPUNCTURE FOR LBP. ACUPUNCTURE AND DN ARE SEPARATE!

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DOCUMENTATION

THESE CODES ARE LISTED IN THE SURGERY/MUSCULOSKELETAL SECTION OF CPT 2020 BUT IT DOES NOT IMPLY DRY NEEDLING IS A SURGICAL PROCEDURE

MUSCLES TREATED EACH VISIT MUST BE IDENTIFIED IN THE HEALTH RECORD

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WHAT DOES THIS MEAN?

NOW THAT DN HAS CPT CODES, DO NOT BILL 97140!!

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INSURANCE WILL MOST LIKELY CONTINUE TO DENY REMIBURSEMENT BECAUSE MEDICARE DOES NOT COVER IT

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MEDICARE PATIENTS MUST BE GIVEN AN ABN! USE GX MODIFIER!

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TIME SPENT NEEDLING MEDICARE PATIENTS IS NOT PART OF YOUR CALCULATED TREATMENT TIME

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EACH CARRIER WILL DETERMINE CODE REIMBURSEMENT

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WHERE TO GO FROM HERE?

  1. THESE CODES HAVE ONLY BEEN ACTIVE SINCE JANUARY 1, 2020

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  • THERE IS NO CONSENSUS AS TO REIMBURSABLE CODES TO BILL ALONG WITH 20560 AND 20561

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  • SINCE MEDICARE DOES NOT COVER IT MANY IF NOT MOST CARRIERS WILL LIKELY DENY IT STILL

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  • ELECTRICAL DRY NEEDLING (EDN) MAY BE BILLED AS ATTENDED ESTIM