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June 22, 2005
MEMORANDUM
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Relevant Documents in .pdf
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TO: AAMA Members
FROM: C. James Dowden
Executive Administrator
RE: New Developments with Acupuncture CPT Codes
We had all hoped that the publication of new CPT codes for acupuncture would see improvement in payments for physician provided acupuncture along with a more reasonable billing system. Academy volunteers, and particularly Marshall Sager, had toiled for several years on the effort. Unfortunately, what was released in the CPT Code book in January 2005 had errors in interpretation and language that only confused, not clarified the application of the new codes. Then, to compound the confusion, CMS published only partial values for the codes when they published the 2005 Physician Fee Schedule, completely omitting the values for Practice Expense.
Now, after months of effort, including calling on Congressional and other contacts for support, Marshall Sager reports that we have been able to fix those problems.
1)CMS finally publishes the full RVUs for Acupuncture Codes
CMS has issued a July Update to the 2005 Physician Fee Schedule that includes the full values for the four new acupuncture codes. This corrects the incomplete listing of values that appeared in January. The complete values reported now include practice expense values. The full published values are as follows:
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97810
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Work RVU
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0.60
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Non Facility Practice Exp. RVU
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0.38
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Facility Practice Exp. RVU
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0.23
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Malpractice RVU
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0.03
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97811
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Work RVU
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0.50
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Non Facility Practice Exp. RVU
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0.25
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Facility Practice Exp. RVU
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0.19
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Malpractice RVU
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0.03
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97813
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Work RVU
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0.65
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Non Facility Practice Exp. RVU
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0.40
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Facility Practice Exp. RVU
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0.25
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Malpractice RVU
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0.03
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97814
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Work RVU
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0.55
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Non Facility Practice Exp. RVU
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0.30
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Facility Practice Exp. RVU
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0.21
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Malpractice RVU
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0.03
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While Medicare will still not cover acupuncture, the Physician Fee Schedule and the published RVU's form the basis for reimbursement by many 3rd party payers. A full copy of the Change Memo from CMS is available here (We omitted pages not relevant to the acupuncture code information. You may also view the entire 22 page document from CMS)
2) AMA has published a clarification regarding the acupuncture CPT codes.
In the June issue of cpt Assistant an article entitled "Coding Clarification: Acupuncture Coding" corrected the error that appears in the 2005 CPT Code book regarding whether you can use codes 97810 and 97811 in the same session as you report codes 97813 or code 97814. This correction makes it clear that the intent of the CPT Committee was to permit mixing of the codes within one session, provided that only one "initial" period code was reported for each session.
The article also provides additional information clarifying that each code is used to report a treatment involving 15 minutes of face-to-face time with the physician, not 15 minutes of time that the needles are inserted. In order for a second code to be reported for the same session, a new insertion of needles must take place.
A copy of the relevant article from the "cpt Assistant" is also available.
In the best of all worlds, insurers and other 3rd party payers would recognize these changes and corrections and would adjust their procedures and payment schedules accordingly. But, it is suggested that Academy members make copies of these documents and submit them to your respective payers to make sure they have the full, "corrected", information needed to properly establish reimbursement levels.
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