Does Medicare Cover Acupuncture?

Medicare began to cover Acupuncture in 2020. However, it is still not covered when rendered under an Acupuncturist license. When the Centers for Medicare and Medicaid Services (CMS) announced their decision to cover acupuncture for chronic low back pain, it generated much confusion among the acupuncture community. While this may be a move in the right direction, as it currently stands, it does not allow for an acupuncturist to bill Medicare.

There are certain requirements one must meet in order to be able to bill Medicare for acupuncture. Medicare dictates that treatment must be administered under the “adequate supervision” of a physician, physician assistant, or nurse practitioner. Unfortunately, acupuncturist do not fall under the term of “adequate supervision” and services must be rendered under an MD/DO, physician assistant, nurse practitioner, clinical nurse specialist, or auxiliary personnel all of which disqualify an acupuncturist. They must also “possess a master’s or doctoral-level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine (ACAOM)” and hold a “current, full, active, and unrestricted license to practice acupuncture” in the state.

In summary, in order to be able to bill to Medicare as an acupuncturist, you must be working under direct supervision of an MD/DO, physician assistant, or nurse practitioner plus the practitioner must also be a Medicare provider. If you have any questions please feel free to reach out to us, we are always happy to help.

Major Change For Low Back Pain Billing

Effective October 1, 2021 the code for Low Back Pain, M54.5, will be deleted from the current ICD10 coding list. The low back pain code is one of the most used codes by providers. To add to code specification, it is being replaced with 3 new coding options:

• M54.50 Low Back Pain, unspecified, includes low back pain and lumbago

• M54.51 Vertebrogenic low back pain

• M54.59 Other Low Back Pain

Please DO NOT use M54.5 effective 10-1-2021 as claims will not be processed

Although we are hoping for a smooth transition with this change, chances are that it will be a rocky start. I would advise not to bill the new back pain codes as primary diagnosis if possible for the first couple of months to avoid potential denials.

Insurance carriers must update all of their policy bulletins to reflect this change in order for carriers to actually pay on these codes. Currently, none are scheduled to do so in October which can interfere with claims processing correctly if billed.

As always, please don’t hesitate to reach out with any questions or concerns!

305-204-1090

anabel@mindfulbillingllc.com

How To Avoid Claim Denials: Top 4 Tips and Tricks

One of the biggest frustrations when submitting acupuncture insurance claims to insurance companies is dealing with denials. Denials cause a huge burden on staff and can have a devastating effect on your practice’s revenue.

From all our years in the holistic billing industry, we have narrowed down the most common claim denials to the top 4.

1. Timely filing- all insurance companies have a window of allowed time to submit your claims. This can vary from one payor to the next and is also practice specific. Whether you are in or out of network with the insurance company will also play a big factor. If the provider is submitting claims and also treating the patients, one can see how this may be a factor. If the front desk also has their hands full, they may already be spread too thin and miss important deadlines.

2. Incorrect or missing modifiers- claim submission is so much more than just a data entry job. Often times the biller and or coder must look at the bigger picture of the claim and append the appropriate modifiers to a claim. If more than one procedure is done on the same day, chances are a modifier is needed.

3. Coding specificity- in the world of ICD-10 coding, coding to the highest specification is extremely important. In fact, ICD-10 was created for this reason alone. ALWAYS code to the highest degree of specificity. Using general diagnosis codes such as "leg pain" instead of "left leg pain" is a sure way to get a denial.

4. No benefits- one of the most important roles of the billing cycle is verifying patient benefits. If a patients plan was not verified accurately, you may be setting yourself up for another denial and leaving the patient with bigger out of pocket cost than expected.

In order to keep your income flowing and your practice flourishing you and your staff should strive for a 95% clean claim rate. This means more than 95% of claims submitted should be processed and paid correctly within the first attempt.

If you or your staff is not meeting this number, it may be time to give us a call!

How Medicare announcing acupuncture coverage has changed the way other carriers pay for acupuncture

On Tuesday, January 21st, 2020, CMS announced their decision to cover acupuncture for chronic low back pain. They since posted their guidelines for coverage which has caused other carriers to adhere to the same rules. 

UHC has also published these guidelines and announced that they will only cover up to 3 units of acupuncture much like the Centers for Medicare have. Optum and Cigna have recently followed as well and it is only a matter of time before other carriers do the same as many have already begun to do so.

We encourage you to follow these guidelines and keep acupuncture treatments at the maximum allowance of 3 units to avoid denials in the future.

As always, we are only a phone call away to answer any questions about your acupuncture billing needs!

E/M changes beginning in 2021

As of January 1, 2021, physicians will select an E/M code based on total time spent on the date of the encounter or medical decision making. Until now all E/M code selection took into account patient history, clinical examination, and medical decision-making. However, evaluation and management codes have now eliminated the history and physical exam as elements for code selection and are primarily based on time.

For new patient exams the time components are as follows:

While established patients time components are as follows:

These new protocols allow the sum of total time related to the encounter on the given date of service. This also allows for non face to face time such as preparing the room, reviewing patients chart, or medical documentation time.

Please reach out to one of our billing experts with any questions!!