CPT codes for Acupuncture Detoxification

[Tifsmom1]

Are there CPT codes for this and are they billable to insurance and Medicaid? The only acupunture codes i am finding are medical and not billable either because they are not in our contract or to Colorado Medicaid.

[PMRNC]

Are there CPT codes for this and are they billable to insurance and Medicaid? The only acupunture codes i am finding are medical and not billable either because they are not in our contract or to Colorado Medicaid.

Procedure codes would be same: 97810-97814, your diagnosis codes will vary, I don't think any insurance would pay for acupuncture for detox, but I could be wrong, I know most carriers only pay it for chronic pain and only if administered by licensed provider within scope of the license for that state. Again, I could be wrong, wouldn't be the first time Medicaid paid for things other working people can't get coverage for. 

[Christy]

Yes, the cpt codes are 97810-97814. More and more carriers are covering acupuncture, even some managed Medicaids in NYS. Medicare and NY straight Medicaid, do not cover, however.

There needs to be a diagnosis code, which should be the condition that the patient is detoxing from....i.e. headache, joint pain, etc....

[PMRNC]

Yes, the cpt codes are 97810-97814. More and more carriers are covering acupuncture, even some managed Medicaids in NYS. Medicare and NY straight Medicaid, do not cover, however.

Not for Detox.. chronic pain.. yes.. i'm in NYS also

There needs to be a diagnosis code, which should be the condition that the patient is detoxing from....i.e. headache, joint pain, etc....

Agree, but the detox is from a substance.. would NOT be headache, joint pain, etc..those would be the diagnosis codes. In many cases the carrier will pay for diagnosis realated to chronic pain.. NOT detoxification..but like I said prior.. I could be wrong. best to check with carrier.

[Christy]

almost all of the carriers in NYS have dropped the requirement of a pain/nausea dx. But yes, benefits must ALWAYS be verified with the carrier. In the case of detox from alcohol or drugs, if that's what the OP meant, if there is a valid DX code that's covered, it is payable. I don't know much about addiction, but say if the person is experiencing nausea as part of the detox, that is a valid dx.

[shanbull]

I actually know of two acupuncturists in Colorado, one of whom also works here at my clinic in Minnesota. I will ask his wife what she knows about billing CO Medicaid (she does all her husband's billing). The other acupuncturist in CO who I know does bill for this type of detox makes a TON of money off cash patients. She does the acupuncture with a vitamin IV drip for business travelers who got a little too into partying on their business trips and either don't want anyone to know or have to go right back into work the next day after not sleeping and being on an airplane. I don't think she bothers with health insurance at all simply because these people pay much more than she'd ever get from insurance.

[Christy]

in NY, acupuncture reimbursement is very good, except for No Fault/WC. For BCBS it's around $130, NYS Empire $150, MVP $200 (they cover 50% of the $200 or so allowed...) Oxford $100

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