How To Use CPT Code 97811

CPT 97811 is an acupuncture procedure code for additional 15-minute increments of manual treatment with re-insertion of needles. This article will cover the description, procedure, qualifying circumstances, when to use, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 97811.

1. What is CPT 97811?

CPT 97811 is a Current Procedural Terminology (CPT) code used to describe an acupuncture procedure involving additional 15-minute increments of manual treatment with re-insertion of needles. This code is used when the provider spends more than the initial 15 minutes of face-to-face time with the patient, performing manual acupuncture treatment and re-inserting the needles during the additional time.

2. 97811 CPT code description

The official description of CPT code 97811 is: “Acupuncture, 1 or more needles; without 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)”.

3. Procedure

The 97811 procedure involves the following steps:

1. Provider locates the insertion sites on the patient’s body.
2. Provider inserts thin, solid, metallic, single-use needles at the identified anatomical points.
3. Provider manually stimulates the needles to achieve the desired therapeutic effect.
4. After the initial 15 minutes of treatment, the provider re-inserts the needles as needed.
5. Provider continues to manually stimulate the needles for each additional 15-minute increment, as necessary.

4. Qualifying circumstances

Patients eligible to receive CPT code 97811 services are those who require additional manual acupuncture treatment beyond the initial 15 minutes. This may include patients with chronic pain, post-operative and chemotherapy-induced nausea and vomiting, stroke rehabilitation, asthma, addiction, and various other health conditions that can benefit from acupuncture therapy.

5. When to use CPT code 97811

It is appropriate to bill the 97811 CPT code when the provider spends more than the initial 15 minutes of face-to-face time with the patient, performing manual acupuncture treatment and re-inserting the needles during the additional time. The code should be used for each additional 15-minute increment of manual treatment, after the initial treatment.

6. Documentation requirements

To support a claim for CPT 97811, the following information should be documented:

• Patient’s medical history and presenting symptoms.
• Provider’s assessment and treatment plan, including the rationale for additional manual acupuncture treatment.
• Specific anatomical points where needles were inserted and re-inserted.
• Duration of each 15-minute increment of manual treatment, including the initial treatment and any additional treatments.
• Provider’s observations and patient’s response to the treatment.
• Any follow-up care or recommendations.

7. Billing guidelines

When billing for CPT code 97811, keep in mind the following guidelines:

• Only one initial acupuncture code (97810 or 97813) can be reported per patient per date of service.
• Report acupuncture based on 15-minute increments of personal, face-to-face time with the patient, not the time the needles are in place.
• Do not report non-electrical stimulation codes (97810 or 97811) in addition to electrical stimulation codes (97813 or 97814) for the same 15-minute increment.
• Use add-on codes 97811 or 97814 for subsequent 15-minute incremental treatments, depending on whether manual or electrical stimulation is used during the additional time.
• If the patient’s condition requires service above and beyond the usual scope of service associated with the acupuncture treatment, report an Evaluation and Management (E/M) service separately, by appending modifier 25.

8. Historical information

CPT 97811 was added to the Current Procedural Terminology system on January 1, 2005. The code was changed on January 1, 2006, with the previous descriptor being “Acupuncture, one or more needles, without 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)”.

9. Similar codes to CPT 97811

Five similar codes to CPT 97811 and how they differentiate are:

• CPT 97810: Initial 15 minutes of manual acupuncture treatment without electrical stimulation.
• CPT 97813: Initial 15 minutes of acupuncture treatment with electrical stimulation.
• CPT 97814: Additional 15-minute increments of acupuncture treatment with electrical stimulation and re-insertion of needles.
• CPT 97140: Manual therapy techniques, such as mobilization and manipulation, for soft tissue and joint structures.
• CPT 97124: Therapeutic massage to promote relaxation, improve circulation, and relieve muscle tension.

10. Examples

Here are 10 detailed examples of CPT code 97811 procedures:

1. A patient with chronic low back pain receives an initial 15 minutes of manual acupuncture treatment (CPT 97810) and requires an additional 15 minutes of treatment with re-insertion of needles (CPT 97811).
2. A patient undergoing chemotherapy experiences nausea and vomiting, and the provider performs 30 minutes of manual acupuncture treatment, including re-insertion of needles after the initial 15 minutes (CPT 97810 and CPT 97811).
3. A patient with migraines receives 45 minutes of manual acupuncture treatment, with needles re-inserted after the initial 15 minutes and again after 30 minutes (CPT 97810 and two instances of CPT 97811).
4. A patient recovering from a stroke receives an initial 15 minutes of manual acupuncture treatment (CPT 97810) and requires an additional 30 minutes of treatment with re-insertion of needles (two instances of CPT 97811).
5. A patient with asthma receives 60 minutes of manual acupuncture treatment, with needles re-inserted after the initial 15 minutes, 30 minutes, and 45 minutes (CPT 97810 and three instances of CPT 97811).
6. A patient with an addiction receives an initial 15 minutes of manual acupuncture treatment (CPT 97810) and requires an additional 45 minutes of treatment with re-insertion of needles (three instances of CPT 97811).
7. A patient with fibromyalgia receives 30 minutes of manual acupuncture treatment, with needles re-inserted after the initial 15 minutes (CPT 97810 and CPT 97811).
8. A patient with carpal tunnel syndrome receives an initial 15 minutes of manual acupuncture treatment (CPT 97810) and requires an additional 15 minutes of treatment with re-insertion of needles (CPT 97811).
9. A patient with chronic neck pain receives 45 minutes of manual acupuncture treatment, with needles re-inserted after the initial 15 minutes and again after 30 minutes (CPT 97810 and two instances of CPT 97811).
10. A patient with anxiety and stress receives an initial 15 minutes of manual acupuncture treatment (CPT 97810) and requires an additional 30 minutes of treatment with re-insertion of needles (two instances of CPT 97811).