Everything you need to know about insurance billing, CPT codes, superbills, and getting your patients reimbursed.
Coverage varies widely by plan and employer — here's the landscape by major insurer:
Coverage varies by state plan. Many BCBS plans cover acupuncture for musculoskeletal conditions (back pain, neck pain, headaches). Check plan-specific benefits. Network acupuncturists required for in-network rates.
Some commercial plans cover acupuncture for chronic pain. Aetna often requires prior authorization and limits to 20 sessions/year. Check Aetna's clinical policy bulletins for current coverage criteria.
Cigna covers acupuncture under many employer-sponsored plans. Coverage typically limited to musculoskeletal pain. Out-of-network benefits may apply with superbill.
UHC covers acupuncture under many commercial plans. Uses Optum as acupuncture benefit manager. Coverage varies significantly by employer plan design.
Some Humana plans include acupuncture coverage, especially Medicare Advantage plans. Commercial coverage is more limited and plan-specific.
Covers up to 20 acupuncture sessions/year for chronic low back pain. Must be performed or supervised by MD/DO/NP/PA. Licensed acupuncturists cannot bill Medicare directly. Medicare acupuncture guide →
Use these CPT codes when submitting claims to insurance:
| CPT Code | Description | Time |
|---|---|---|
| 97810 | Acupuncture, 1 or more needles, without electrical stimulation — initial 15 min | First 15 min |
| 97811 | Acupuncture, 1 or more needles, without electrical stimulation — each additional 15 min | +15 min increments |
| 97813 | Acupuncture, 1 or more needles, with electrical stimulation — initial 15 min | First 15 min |
| 97814 | Acupuncture, 1 or more needles, with electrical stimulation — each additional 15 min | +15 min increments |
Call the member services number on the back of the patient's insurance card.
Ask specifically: "Does this plan cover acupuncture services?" and "What is the CPT code coverage for 97810 and 97811?"
Ask about: deductible status, co-pay/co-insurance amount, visit limits per year, prior authorization requirements, and whether you need to be in-network.
Get a reference number for the call and document: date, representative name, reference number, and coverage details confirmed.
If in-network required — check payer's provider directory or apply to join their network through their provider portal.
Pro tip: Many practitioners use Availity (availity.com) or individual payer portals to verify benefits online without calling — saves 15–20 min per new patient.
Even when you're out-of-network, patients with PPO plans can often get partial reimbursement using a superbill.
See the full patient superbill guide → for a patient-friendly walkthrough you can share in your practice.
Medicare Part B covers up to 20 acupuncture sessions/year for chronic low back pain. Sessions must be performed or supervised by a physician (MD, DO), nurse practitioner, or physician assistant.
Important: Licensed Acupuncturists (L.Ac., DAOM) cannot bill Medicare directly. Sessions must be performed or directly supervised by an MD, DO, NP, or PA.
Every session needs Subjective (patient report), Objective (findings), Assessment (pattern/diagnosis), Plan (treatment, follow-up). Required for all insurance claims.
Document medical necessity with specific diagnosis codes. Common codes: M54.5 (Low back pain), M54.2 (Cervicalgia), G43.909 (Migraine), F41.1 (Generalized anxiety), N97.9 (Female infertility).
Document functional limitations and treatment goals. Example: "Patient reports 7/10 pain with ADL limitations. Goal: reduce to 3/10, restore full ROM within 8 sessions."
If required, document clinical necessity before the first session. Keep the PA number in the patient chart.
Retain all documentation for 7 years minimum. Keep signed intake forms, consent forms, SOAP notes, and insurance communications.
Acupuncture Digest connects patients with licensed practitioners nationwide. Claim your listing and start receiving patient inquiries.