Introduction
Dry needling and acupuncture are both needle-based treatments, but they serve different purposes and require distinct CPT codes for proper billing. Accurate CPT coding ensures appropriate reimbursement and prevents claim denials due to incorrect coding or bundling issues. This guide covers key CPT codes for dry needling and acupuncture, along with billing guidelines, modifier use, and a final reference table with CPT descriptions and RVUs.
Understanding Dry Needling vs. Acupuncture
- Dry Needling (Trigger Point Therapy) – A technique used by physical therapists and other healthcare providers to relieve muscle pain and improve mobility.
- Acupuncture – A traditional Chinese medicine practice that stimulates specific meridian points to restore balance and alleviate pain.
- Medicare & Insurance Considerations – Medicare does not reimburse for dry needling but may cover acupuncture under certain conditions.
CPT Codes for Dry Needling & Acupuncture
Dry Needling CPT Codes
- 20560 – Needle insertion(s) without injection; 1-2 muscle groups.
- 20561 – Needle insertion(s) without injection; 3 or more muscle groups.
Acupuncture CPT Codes
- 97810 – Acupuncture, without electrical stimulation, initial 15 minutes.
- 97811 – Acupuncture, without electrical stimulation, additional 15 minutes.
- 97813 – Acupuncture, with electrical stimulation, initial 15 minutes.
- 97814 – Acupuncture, with electrical stimulation, additional 15 minutes.
Billing Guidelines & Modifier Usage
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Common Modifiers:
- -GP – Services performed under a therapy plan of care.
- -59 – Distinct procedural service (if billed alongside another treatment).
- -25 – Used when an E/M service is performed on the same day.
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Bundling Considerations:
- Dry needling (20560, 20561) is not reimbursable by Medicare but may be covered by private insurers.
- Acupuncture (97810-97814) may require medical necessity documentation for insurance coverage.
Common Denials & How to Avoid Them
- Medical Necessity Denials: Ensure documentation specifies pain conditions and therapeutic need.
- Modifier Use Issues: Append -GP or -59 modifiers when necessary.
- Insurance Coverage Issues: Verify payer policies, as Medicare only covers acupuncture for chronic low back pain.
Final CPT Code Table: Descriptions & RVUs
| CPT Code | Description | RVU |
|---|---|---|
| 20560 | Dry needling, 1-2 muscle groups | 0.75 |
| 20561 | Dry needling, 3 or more muscle groups | 0.90 |
| 97810 | Acupuncture, initial 15 minutes | 0.80 |
| 97811 | Acupuncture, additional 15 minutes | 0.50 |
| 97813 | Acupuncture with electrical stimulation, initial 15 minutes | 0.90 |
| 97814 | Acupuncture with electrical stimulation, additional 15 minutes | 0.60 |
Conclusion
Accurate CPT coding for dry needling and acupuncture is essential for maximizing reimbursement and preventing denials. Understanding insurance coverage differences, modifier application, and payer-specific guidelines will help ensure accurate claims.
If this guide was useful, check out our other rehabilitation CPT coding guides on physical therapy, manual therapy, and osteopathic manipulation!