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Acupuncture visit and insurance coding

Is Your Insurance Company counting portions of your

Acupuncture Visits as Physical Therapy?

Many of our patients submit a visit statement to their insurance company to receive reimbursement for their treatment costs. Recently some of our patients are having physical medicine codes used in their acupuncture treatment counted as a physical therapy (PT) visit! This can be a problem for a few reasons.

  1. Some policies have a limit on the number of PT visits they can have in a year. If they apply a code as a PT visit it will reduce the number of visits available for that service. This affects patients who are only allowed a limited number of physical therapy visits for the year. This is of particular concern for those patients who rely on both acupuncture and physical for optimal wellness.
  2. The charges for the physical medicine codes are much smaller than a charge for a PT visit.
  3. Some companies are not covering the code, and still counting it as a PT visit

These codes fall within the scope of practice for acupuncture treatment and are commonly billed codes among acupuncturists. Although both of our practitioners are licensed acupuncturists and certainly not physical therapists, these physical medicine codes are counted as a physical therapy visit for some patients.

The specific codes that we bill that may be counted toward a PT visit are:

97026 Infrared Heat-

The application of infrared therapy is considered medically necessary for patients requiring the application of superficial heat in conjunction with other procedures or modalities to reduce or decrease pain/produce analgesia or reduce stiffness/tension, myalgia, spasm, or swelling.

97140 Manual Therapy-

Techniques such as mobilization and manipulation, manual lymphatic drainage, and manual traction, one or more regions, each 15 minutes with direct (one-on-one) patient contact.

Please note that this isn’t the case for everyone. Additionally, not all plans count BOTH codes toward a physical therapy visit. However, it is important to be aware in case this is unknowingly happening to you, or if you are considering using your physical therapy benefits at any time.

We do our best to offer valuable care at a reasonable cost, and to be aware of your insurance benefits and help you use them wisely. Please let us know if this issue is affecting you. We can put these charges on the non- billable area of your statement to prevent your benefits being used incorrectly. If you have any questions please call Chandra at our office, 610-431-2008, she will be glad to help you!

Margaret Sheehan, LOM

Margaret has been involved in holistic health since 1983, first as a massage therapist, tai chi and qi gong instructor. She was clinical director of the Alternative Medicine Network of the Jefferson Health System, Mainline 1995-1997. In 2001 she graduated from the Pacific College of Oriental Medicine, Manhattan, with a Master of Traditional Oriental Medicine Degree. She has taught university classes and workshops. She was cofounder of Chester County Herbs and Acupuncture in 2001, which became Oriental Medicine of West Chester in 2016. Her goal is to see Oriental Medicine care take its place in the healing and health care community of West Chester.

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