Acupuncture: Billing and Coding

Background
Acupuncture is an alternative to manipulating specific acupuncture points through the insertion of needles or "needling" or other "non-essential" methods that focus on those points. The NCD for Acupuncture (30.3), published in May 1980, states that Medicare reimbursement cannot be made for acupuncture, as an anesthetic or analgesic, or for other therapeutic purposes. Accordingly, acupuncture is not considered reasonable and necessary within the meaning of section 1862(a) (1) of the Social Security Act (the Act). In 2004, we reviewed the use of acupuncture for fibromyalgia and determined that there is no clear evidence for the use of acupuncture for pain relief in patients with fibromyalgia (NCD 30.3.1). Likewise, in the same year, we concluded that there is no clear evidence for the use of acupuncture for pain relief in patients with arthritis (NCD 30.3.2).

Effective General Information

• Beginning January 21, 2020, or after January 21, 2020, the MAC will recognize and pay for acupuncture for cLBP services used in CPT codes 97810, 97811, 97813, 97814, 20560, and 2056 jobs on CD covered. 3. 
• The ICD-10 diagnostic code can be found in the appendix to CR 11755 and one of the above CPT codes must be reported for acupuncture for cLBP operations. 
• MAC will accept claims with the -KX modifier for 8 more services (in addition to the first 12 in 90 days) for a maximum of 20 visits in 12 months. By adding the -KX modifier to the claim, the therapist approves and other medically necessary services, such as appropriate supporting documents and medical records.

Company Billing Form and Funding Information

• Effective January 21, 2020, or after January 21, 2020, MAC will recognize acupuncture for cLBP services reported on the Company Statement and Billing Form (TOB) 012X, 013X, 71X, 775X, and 08. acupuncture billing codes are separate from 096X, 097X, and 098X for Method 1 Critical Access Hospitals (CAHs).
  
  • Effective January 21, 2020, or after January 21, 2020, the MAC will recognize acupuncture for cLBP services that are reported with revenue code 0940 on the company statement.
• Effective on or after January 21, 2020, MAC will recognize acupuncture for cLBP services reported for facility claims on TOB 085X CAH Method II with revenue codes 096X, 097X, and 098X.
• MACS will reject/deny claims in DOS on or after January 21, 2020, without the required CPT and ICD-10 diagnostic codes using the following information: service because the payer does not take it as "medical necessity". 
• Delivery Advice Notification Code (RARC) M64 - Additional information is missing / incomplete / incorrect. 
• Code Group CO (contract work) or PR (patient work) depending on the work. In addition to the codes listed above, MAC will provide all rejects with the right to appeal. 
• MAC must be returned to the provider/return as an uncorrected claim for acupuncture for cLBP for more than 12 services per year without the modifier -KX and use the following information: 
• CARC 4 - Code Procedure does not match the variable used or the required variable is missing. Note: Refer to Health Care Identification Part 835 (loop 2110 REF Payment Information) if applicable 
• RARC N657 - This payment should be made with the appropriate code for these services • CO Group Code
• MAC will reject/refuse more than 20 acupuncture services for cLBP say every year using the following information: 
• CARC 96 - Not covered (s) costs. At least one notification code must be issued (can include either an NCPDP rejection code or a non-ALERT delivery advisory correction code), if applicable 
• RARC N640 - exceed number / recommended frequency / allow and time
• CO MAC one code will not need acupuncture for cLBP says in DOS on or after January 21, 2020, but will fix the statement you bring them a warning. In the most recent national coverage review for targeted acupuncture for cLBP, we decided to cover acupuncture for cLBP under section 1862(a) (1) (A) of the applicable law for DOS claims as of January 21, 2020. and 12 visits in 90 days are covered for patients under the following conditions: 

For the purposes of this decision, LBPc is defined as:

• Duration of 12 weeks or more 
• Having is not specific, in the sense that there is no causal mechanism (for example it is not associated with metastatic, inflammatory, disease, etc. disease)
• Not associated with surgery
• Not associated with pregnancy we will cover another 8 periods for patients who show improvement.