CPT Code 97810 | Description, Procedure & Billing Guidelines (2022)
Report CPT 97810 for the initial 15 minutes of acupuncture treatment with electrical and non-electrical stimulation.
1. What Is CPT Code 97810?
CPT 97810 covers an acupuncture procedure in which a provider uses fine, metallic, solid, and single-use needles to pierce the skin to stimulate anatomical points either in or on the patient’s skin.
The total time of this procedure is 15 minutes and aims to provide treatment, prevention, or relief of;
- addiction;
- asthma;
- strokes;
- vomiting;
- post-operative nausea;
- post-operative chemotherapy;
- pain; and
- other health conditions.
2. Description
The official CPT manual describes CPT 97810 as: “Acupuncture, one or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient.”
3. Procedure
During the acupuncture procedure, as described by CPT 97810, a provider uses one-time, disposable, metallic, solid, hair-thin needles and inserts them into the skin at points connected to organs, muscles, and/or nerves. The provider locates these critical points by pressing the patient’s skin with their fingers.
The 97810 CPT code procedure starts with the provider locating the critical points on the patient’s skin. Next, they marks the sites and cleans them.
Then, they select needles of the correct length and start instering the needles into the marked sites. Simultaneously, they simulate the needles mildly and may use different techniques that cause other effects.
Next, they instruct the patient to rest with the needles still in place. During this time, they check on the patient and readjust needles if necessary.
Then, they remove the needles once the desired effect is achieved. Bleeding or bruising is prevented by pressing the site with a cotton ball. Finally, they give the patient instructions before they chart this procedure.
4. How To Use CPT Code 97810
Be aware that the resting time of the patient is not part of the procedure and can not be counted. Therefore, only the provider’s actual time with the patient during the CPT 97810 procedure can be billed.
CPT code 97810 can only be used for the initial 15 minutes of the acupuncture treatment. Report CPT 97811 or CPT 97814 for subsequent 15-minute incremental treatments. Only bill these codes if the needles are re-inserted.
You can not use CPT code 97810 in addition to CPT 97813 or CPT 97814.
TIP: You can find all the CPT codes for acupuncture here.
CPT 97810 can only be billed once per day. This code includes the initial service to identify the need for acupuncture, setting everything up, the treatment, and patient evaluation.
97810 can be used for electrical and non-electrical stimulation.
4.1 Does CPT Code 97810 Need A Modifier?
You can add modifier 25 to CPT 97810 if the condition of the patient requires beyond and above the standard service level of ‘normal’ acupuncture. Usually, another E/M service is provided at the same time. You can report his procedure separately with modifier 25.
4.2 Does Medicare Cover CPT Code 97810?
Yes, CPT code 97810 is covered if it is used to treat back pain according to CMS.
5. Resources
https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&NCAId=295
https://www.mayoclinic.org/tests-procedures/acupuncture/about/pac-20392763
https://www.mass.gov/doc/acupuncture-services-acu-subchapter-6/download
