Acupuncture CPT Codes – 2026 Guide: CPT 97810, 97811, 97813, 97814

Quick Reference:

• What these codes mean: CPT 97810 and +97811 report acupuncture without electrical stimulation (manual acupuncture) in 15-minute units of personal one-on-one contact. CPT 97813 and +97814 report acupuncture with electrical stimulation (electroacupuncture) in the same 15-minute structure.
• Only one "initial" code per session/date of service: You typically report either 97810 (manual) or 97813 (electro) once per encounter/day, then use the appropriate add-on code(s) for additional time. Add-on codes 97811 and 97814 are reported only in addition to the primary code family and reflect additional 15-minute increments as defined in CPT/CMS guidance.
• Time is provider-patient, not "needle dwell time": These codes are based on direct personal contact time. The time the patient is left resting with needles inserted without personal one-on-one provider contact is not the billable timed service. Payers that publish reimbursement guidance emphasize that "face-to-face"/direct contact time is the unit driver.
• Counting units uses standard Medicare timed-code thresholds: Medicare's timed-code guidance uses midpoint logic (commonly operationalized as the "8-minute rule") for 15-minute units. In practical terms, time thresholds determine whether you have 1 unit versus multiple units. This is a documentation and audit focal point for timed services billed in 15-minute increments.
• Do not unbundle electrical stimulation when billing electroacupuncture: When the service is properly reported with 97813/97814, separate electrical stimulation modality reporting is typically considered duplicative when performed as part of the electroacupuncture service. Commercial reimbursement policies explicitly describe e-stim as included when electroacupuncture is reported, unless a truly distinct service is documented and separately billable under payer rules.
• Medicare coverage is narrow and diagnosis-driven: Original Medicare (Part B) covers acupuncture only for chronic low back pain (cLBP) under the national coverage determination. It allows up to 12 visits in 90 days, with up to 8 additional visits (maximum 20 in a 12-month period) if the patient demonstrates improvement; treatment should stop if there is no improvement.
• Medicare-qualified practitioners are specified: Medicare's national policy defines who may furnish covered acupuncture for cLBP (physicians and certain practitioners/auxiliary personnel meeting specified education/licensure requirements). This is a frequent denial and compliance issue when the rendering/billing setup does not match the NCD requirements.
• Modifier essentials for non-covered services: For Medicare, when a service is expected to be denied, correct use of ABN-related modifiers (e.g., GA) and statutory exclusion signaling (e.g., GY) follows Medicare non-covered services billing guidance. These modifiers do not "make a service covered," but they affect liability assignment and clean processing.

CPT 97810, 97811, 97813, and 97814 are the core CPT codes for reporting acupuncture in 15-minute timed units.

Most compliance risk is concentrated in four areas:

1. coding time that is not "personal one-on-one contact" time,
2. billing more than one "initial" service per date without support,
3. unbundling electrical stimulation when electroacupuncture is reported, and
4. billing Medicare outside the narrow chronic low back pain coverage pathway.

This 2026-focused guide aligns the code definitions, Medicare coverage rules, and payer-realistic documentation expectations so your claims are both payable and defensible.

1. Definitions and Code Scope

flowchart TD
    A[Acupuncture Service Performed] --> B{Electrical stimulation used?}
    B -->|No| C["97810 – Manual, Initial 15 min"]
    B -->|Yes| D["97813 – Electro, Initial 15 min"]
    C --> E{Additional direct contact time beyond 15 min?}
    D --> F{Additional direct contact time beyond 15 min?}
    E -->|Yes| G["+97811 – Each Add'l 15 min"]
    E -->|No| H[Report 97810 only]
    F -->|Yes| I["+97814 – Each Add'l 15 min"]
    F -->|No| J[Report 97813 only]
    G --> K[Apply 8-minute rule for unit count]
    I --> K

The acupuncture code family is organized by (a) whether electrical stimulation is used and (b) whether the billed unit represents the initial 15-minute period or an additional 15-minute increment. CMS billing instructions reiterate the 15-minute structure and the "one initial per date" concept for correct code assignment.

1.1 CPT 97810 (manual acupuncture, initial 15 minutes)

97810 reports acupuncture without electrical stimulation for the initial 15 minutes of personal one-on-one contact with the patient. It is the "base" code for manual acupuncture in a session. Use 97810 when the service is manual (no e-stim) and the record supports at least one billable timed unit of direct provider-patient contact. CMS instructions emphasize the timed unit nature of the code set and that the "initial" code is not intended to be repeated as multiple units.

1.2 CPT +97811 (manual acupuncture, each additional 15 minutes)

+97811 is an add-on code for each additional 15 minutes of personal one-on-one contact for manual acupuncture beyond the initial unit. Add-on status means it is reported only in addition to the primary procedure code (97810) in typical workflows. Operationally, the add-on unit should be supported by continued billable direct contact time and a treatment record consistent with CPT/CMS billing instructions for timed acupuncture services.

1.3 CPT 97813 (electroacupuncture, initial 15 minutes)

97813 reports acupuncture with electrical stimulation for the initial 15 minutes of personal one-on-one contact. In a compliant note, the technique section should explicitly document electrical stimulation as part of the acupuncture service. CMS billing instructions treat the electroacupuncture codes as the parallel family to the manual codes, distinguished by the use of electrical stimulation.

1.4 CPT +97814 (electroacupuncture, each additional 15 minutes)

+97814 is the add-on code for additional 15-minute increments when electrical stimulation is used. As with +97811, it is reported as additional timed units beyond the initial code. A payer-realistic compliance point is that electroacupuncture reporting typically renders separate electrical stimulation modality billing duplicative unless a distinct service is clearly supported (different service, different clinical purpose, and payer rules that allow separate reimbursement).

High-yield coding boundary: Do not report multiple "initial" acupuncture codes (e.g., 97810 and 97813) for the same session/day as a strategy to represent technique changes. Your claim should reflect one initial service in the family and additional time with add-on units per CMS coding instructions.

2. Time Rules and Unit Calculation

Time is the audit pivot for these codes. The code descriptors use 15-minute timed units tied to personal one-on-one contact. This means your documentation must support (1) total minutes of billable direct contact and (2) correct conversion of minutes into units (initial plus add-on increments). Commercial reimbursement guidance for acupuncture emphasizes that direct contact time -- rather than passive needle retention -- is what drives reporting.

2.1 What counts as billable time

• Count: provider time spent in direct, personal one-on-one contact performing the acupuncture service (assessment related to the procedure, needle insertion/removal, manual stimulation, applying and adjusting electrical stimulation when relevant, monitoring and interacting with the patient as part of the acupuncture service).
• Do not count: time the patient rests with needles inserted without personal one-on-one provider contact (often described as "dwell time"). Payer guidance explicitly contrasts face-to-face/direct contact time with unattended needle retention.

2.2 Converting minutes to billable units

Medicare timed-code guidance explains unit conversion using midpoint thresholds (commonly operationalized as the "8-minute rule") for 15-minute services. While acupuncture is not a therapy modality code set, it is still a 15-minute timed service family, and the same timed-code unit logic is widely applied in claims review for 15-minute increments. As a practical claims rule, you should be able to show the total direct contact time and that your unit count matches standard Medicare thresholds for timed services.

Common thresholds used in practice for a single 15-minute timed service family: 8-22 minutes = 1 unit; 23-37 minutes = 2 units; 38-52 minutes = 3 units; 53-67 minutes = 4 units, etc.

Documentation minimum: Record total billable one-on-one minutes (or start/stop) per session. If you bill add-on units, your note should make it reasonable for an auditor to understand why more than one unit is supported (continued one-on-one contact, continued skilled service).

3. Medicare Coverage and Benefit Limits

Medicare is the highest-impact payer for compliance rules because it has a narrow national coverage pathway. Under the national coverage determination, Medicare Part B covers acupuncture only for chronic low back pain (cLBP) and only under defined conditions, with explicit visit limits and a requirement to discontinue if the patient is not improving.

3.1 Covered indication: chronic low back pain (cLBP)

Medicare's NCD defines cLBP as low back pain lasting 12 weeks or longer and specifies clinical boundaries (including that it is not associated with certain excluded contexts). The key operational point is that Medicare coverage is not "acupuncture generally," but a limited benefit for cLBP only. Claims that read as "general pain" or a different anatomic region are at high risk of denial under the NCD framework.

3.2 Visit limits and improvement requirement

Medicare covers up to 12 acupuncture visits in 90 days for cLBP. If the patient demonstrates improvement, Medicare may cover an additional 8 visits, for a maximum of 20 visits in a 12-month period. If the patient is not improving or is worsening, treatment should be discontinued under the coverage policy. Medicare beneficiary-facing guidance mirrors these limits and discontinuation expectations.

3.3 Who can furnish covered acupuncture under Medicare

Medicare's national policy specifies the practitioner requirements for covered acupuncture. This is a common denial point: even when the patient has cLBP and the time coding is correct, claims can fail if the furnishing/billing arrangement does not meet Medicare's NCD requirements. Medicare's public coverage summary aligns with the policy and describes the practitioner limitation in plain language.

Medicare compliance checkpoint: Your record should clearly support (1) cLBP diagnosis/indication, (2) that the visit count is within Medicare limits, and (3) improvement documentation when continuing past the initial covered course.

4. Documentation Standards and ICD-10 Positioning

Documentation must support both coded time and medical necessity. Medicare's acupuncture coverage is contingent on the cLBP pathway, and commercial payers commonly require evidence of progress for continued care. A payer-realistic note should make it easy to answer: (1) what was done, (2) how long did direct one-on-one service occur, and (3) why the service is medically necessary today.

4.1 Minimum documentation elements (session level)

• Indication: the condition being treated (e.g., chronic low back pain) and relevant severity/function markers.
• Technique: manual vs electrical stimulation clearly stated; if electrical stimulation is used, document that it was part of the acupuncture service.
• Time: total billable personal one-on-one contact minutes (or start/stop times) supporting the unit count.
• Treatment detail: sufficient clinical detail to show a delivered service (commonly points/regions treated and general technique), consistent with your practice and payer expectations.
• Response/progress: patient response today and trend over time; Medicare continuation requires improvement for additional visits.

4.2 ICD-10 positioning for Medicare cLBP claims (practical)

Medicare coverage is diagnosis-driven under the NCD. Your ICD-10 selection should credibly support "chronic low back pain" and align with the documentation. While coding systems evolve, the core compliance requirement is that the diagnosis and the record tell the same story: low back pain that meets the chronicity threshold and fits within the NCD definition. Medicare's coverage documentation is the controlling authority for what is payable under Original Medicare.

4.3 Distinguish acupuncture from other services billed same day

If you bill an E/M service on the same date, your documentation should separate the E/M work from the acupuncture procedure note. This matters for modifier 25 use and for ensuring acupuncture time is not inflated by non-procedure evaluation time. Commercial reimbursement policies highlight that timed code units are based on direct contact for the acupuncture service itself.

5. Modifier Usage and Common Edit Scenarios

Modifiers do not create coverage; they communicate claim context. For acupuncture, modifier use is most consequential when the service is non-covered under Medicare or when you bill a separate E/M or distinct procedure on the same date. Medicare non-covered services guidance is the authoritative anchor for ABN-related modifiers and statutory exclusion signaling.

5.1 Medicare ABN and non-covered modifiers (GA, GY, GX concepts)

• GA: append when an ABN is on file for a service you expect Medicare to deny as not reasonable and necessary or otherwise non-covered in the specific context, so liability is properly assigned.
• GY: append to indicate the item/service is statutorily excluded or not a Medicare benefit, which drives an automatic denial.
• GX: used to report that a voluntary ABN was issued for a service that is not covered. (Operationally relevant when you want documentation that notice was provided, even if not required.)

5.2 Modifier 25 (E/M same date)

When a significant, separately identifiable E/M service occurs on the same date as acupuncture, modifier 25 may be appended to the E/M code, provided documentation supports a distinct evaluation beyond the minimal work inherent to the procedure visit. This is not acupuncture-specific; it is general claims logic. Your record should make it obvious why an E/M was separately necessary (new problem, meaningful reassessment with management decision-making, etc.).

5.3 Electrical stimulation unbundling caution

When you report electroacupuncture (97813/97814), payer reimbursement guidance commonly treats electrical stimulation as included. Billing separate electrical stimulation codes in the same context is a frequent denial trigger unless you have a clearly distinct service supported by payer policy and documentation. Treat "separate e-stim billing" as an exception requiring strong documentation, not as routine practice.

6. Commercial Payer Pattern and Medical Policy Alignment

Commercial coverage varies widely, but two themes are stable: (1) medical policies define indications and limits, and (2) reimbursement policies define how the codes are paid and what is considered inclusive. Aetna's clinical policy bulletin is a typical example of how commercial payers list covered indications and non-covered/experimental conditions, while UnitedHealthcare's reimbursement policy is a typical example of how payers operationalize time, unit limits, and bundling expectations.

6.1 Condition-based medical necessity (example: Aetna CPB)

Commercial policies often state that acupuncture is medically necessary for certain pain syndromes or other defined indications and not medically necessary or investigational for others. Aetna's policy is explicit in distinguishing covered use cases from a large set of conditions it considers experimental/unproven, and it commonly conditions continuation on evidence of improvement within a defined timeframe. Use this as a model: your documentation should reflect why the patient meets the payer's "covered indication" criteria and show measurable progress when ongoing treatment is billed.

6.2 Reimbursement mechanics (example: UHC)

Commercial reimbursement policies often specify unit structure, direct contact time principles, and inclusions such as supplies and certain modality overlaps. UnitedHealthcare's policy describes how 97810-97814 are treated as timed services and reinforces that time is direct contact, and it outlines common reimbursement behaviors (including treatment of electrical stimulation and other components). Use these payer rules as a practical checklist when you see consistent denials in a commercial population.

Operational best practice: For commercial plans, check both (a) the plan's medical policy (what diagnoses/indications are covered and under what conditions) and (b) the plan's reimbursement policy (how the CPT codes are processed, timed, and bundled).

7. Comparison Table: 97810 vs 97811 vs 97813 vs 97814

8. Clinical Scenarios with Claim-Ready Examples

Scenario 1: Medicare cLBP, initial course (manual acupuncture, 30 minutes)

Patient: Medicare Part B beneficiary with chronic low back pain meeting NCD criteria.

Service: Manual acupuncture with documented direct one-on-one contact totaling 30 minutes.

Coding: 97810 + 97811 (2 units total based on timed thresholds).

Coverage logic: Payable only if within Medicare's visit limits and the documentation supports cLBP and medical necessity.

Documentation tip: Include total direct-contact minutes, lumbar pain measures, and functional progress markers to support continuation if needed.

Scenario 2: Medicare cLBP, continuation toward annual max (electroacupuncture, 45 minutes)

Patient: Medicare beneficiary at visit 13-20 window with documented improvement.

Service: Electroacupuncture with direct one-on-one contact totaling 45 minutes.

Coding: 97813 + 97814 x 2 (3 units total based on timed thresholds).

Coverage logic: Medicare allows additional visits only when improvement is demonstrated, up to the annual maximum.

Compliance tip: Do not bill separate electrical stimulation modality codes as routine add-ons to electroacupuncture absent a clearly distinct, separately billable service per payer policy.

Scenario 3: Medicare non-covered indication (e.g., headache), patient requests claim submission

Patient: Medicare beneficiary seeking acupuncture for a non-covered condition (not cLBP).

Service: Manual acupuncture, 15 minutes of direct one-on-one contact.

Coding (if submitting for denial): 97810 with GY to indicate the service is excluded/not a Medicare benefit for that indication, per Medicare non-covered services guidance.

Financial/liability step: Use ABN workflow when appropriate and apply ABN-related modifiers as directed by Medicare guidance for expected denials.

Scenario 4: Commercial plan, covered pain indication with medical policy limits

Patient: Commercially insured patient with a covered indication under the payer's medical policy.

Service: Manual acupuncture with 30 minutes of direct contact time.

Coding: 97810 + 97811 (2 units), consistent with timed-unit logic and payer reimbursement expectations.

Medical necessity tip: Document baseline severity and measurable progress, because many medical policies condition continuation on improvement.

Scenario 5: Same-day E/M plus acupuncture (commercial or Medicare-appropriate context)

Patient: New patient requiring a separately identifiable evaluation (history, exam as needed, assessment/plan) plus acupuncture.

Service: Distinct E/M plus manual acupuncture with 15 minutes of direct contact time.

Coding: Appropriate E/M code with modifier 25 (when supported) + 97810.

Documentation tip: Separate the E/M note from the acupuncture procedure note; ensure acupuncture time does not include E/M time.