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Acupuncture is a therapeutic practice rooted in traditional Chinese medicine, primarily utilized for pain management and various health conditions. This technique involves the insertion of thin, sterile needles into specific points on the body, known as acupuncture points. The primary goal of acupuncture is to stimulate these points to enhance the flow of chi, or vital energy, through the body's meridian pathways. By doing so, acupuncture aims to restore balance and promote healing within the body. In addition to traditional needle insertion, acupuncture can be combined with other modalities such as moxibustion and cupping therapy. Moxibustion involves the burning of moxa, a dried herb, either on or near the skin to encourage healing, while cupping therapy creates localized suction to improve blood circulation and facilitate recovery. Acupuncture can be performed with or without electrical stimulation. When electrical stimulation is used, the needles are connected to a generator that delivers continuous electrical pulses, enhancing the therapeutic effects of the treatment. For billing purposes, specific CPT® codes are designated for different aspects of acupuncture: code 97810 is used for the initial 15 minutes of acupuncture without electrical stimulation, 97811 for each additional 15 minutes without electrical stimulation, 97813 for the first 15 minutes with electrical stimulation, and 97814 for each additional 15 minutes with electrical stimulation, including the insertion of needles.
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The procedure of acupuncture with electrical stimulation is indicated for various conditions, particularly those related to pain management and the enhancement of overall well-being. The following are specific indications for which this procedure may be performed:
The procedure for acupuncture with electrical stimulation involves several key steps, which are detailed below:
After the acupuncture procedure with electrical stimulation, patients may experience a range of effects. It is common for patients to feel relaxed and may report a reduction in pain or discomfort. Practitioners often provide post-procedure care instructions, which may include recommendations for hydration, rest, and avoiding strenuous activities for a short period. Patients are also advised to monitor their symptoms and report any unusual reactions or prolonged discomfort. Follow-up appointments may be scheduled to assess progress and determine the need for additional treatments.
| Short Descr | ACUP 1/> W/ESTIM EA ADDL 15 | Medium Descr | ACUPUNCTURE 1/> NDLS W/ESTIM EACH ADDL 15 MIN | Long Descr | Acupuncture, 1 or more needles; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with insertion of needle(s) (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Packaged into APC Rates | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 2 | CCS Clinical Classification | 213 - Physical therapy exercises, manipulation, and other procedures |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 97810 | MPFS Status: Active Code APC S PUB 100 CPT Assistant Article Acupuncture, 1 or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient | 97813 | MPFS Status: Active Code APC S PUB 100 CPT Assistant Article Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient |
| KX | Requirements specified in the medical policy have been met | GA | Waiver of liability statement issued as required by payer policy, individual case | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | GZ | Item or service expected to be denied as not reasonable and necessary | GP | Services delivered under an outpatient physical therapy plan of care | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | 24 | Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period: the physician or other qualified health care professional may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. this circumstance may be reported by adding modifier 24 to the appropriate level of e/m service. | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | AT | Acute treatment (this modifier should be used when reporting service 98940, 98941, 98942) | GC | This service has been performed in part by a resident under the direction of a teaching physician | GT | Via interactive audio and video telecommunication systems | GW | Service not related to the hospice patient's terminal condition | GX | Notice of liability issued, voluntary under payer policy | KA | Add on option/accessory for wheelchair | KC | Replacement of special power wheelchair interface | KS | Glucose monitor supply for diabetic beneficiary not treated with insulin | KW | Dmepos item subject to dmepos competitive bidding program number 4 | KY | Dmepos item subject to dmepos competitive bidding program number 5 | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | X1 | Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
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Date
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Action
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Notes
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|---|---|---|
| 2025-01-01 | Changed | Short, Medium, and Long Descriptions changed. |
| 2006-01-01 | Changed | Code description changed. |
| 2005-01-01 | Added | First appearance in code book in 2005. |
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