Acupuncture Medical Billing & Credentialing Services

Common Billing Challenges in Acupuncture

• Variable coverage between commercial and Medicaid/Medicare plans

• CPT limitations for multiple units and modalities (e.g., 97810, 97811)

• Documentation requirements to support medical necessity and duration of service

• Denials due to state scope-of-practice rules or improper use of modifiers

Oakview’s Acupuncture Billing Solutions

Coding support for:
• 97810 – Acupuncture without electrical stimulation (initial 15 min)
• 97811 – Each additional 15 min without electrical stimulation
• 97813 – With electrical stimulation (initial 15 min)
• 97814 – Each additional 15 min with electrical stimulation
Modifier guidance (e.g., 59, 25) for properly unbundling procedures
Verification of insurance coverage for acupuncture by payer
Real-time eligibility checks and prior authorization workflows
Clean claim submission and follow-up for denied acupuncture claims
Credentialing with plans that recognize acupuncturists as independent providers