2025 CPT code 97811
(Active) Effective Date: N/A Medicine - Acupuncture Feed
Acupuncture, one or more needles; without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure).
Modifier 25 may be appended to an evaluation and management (E/M) code if a significant, separately identifiable E/M service is performed in addition to the acupuncture treatment.
Acupuncture for chronic low back pain is covered by CMS under specific circumstances. Documentation should demonstrate that the patient meets the criteria for chronic low back pain and the acupuncture is being used for pain relief.
The healthcare provider locates and inserts thin, disposable needles into specific points on the patient's body. The needles are then manually manipulated to stimulate the points. The provider monitors the patient and readjusts needles as needed during the treatment period.
In simple words: This code covers the additional time a healthcare provider spends performing manual acupuncture (inserting thin needles into specific body points) after the initial treatment, including reinserting needles, if needed. It is used for each 15-minute period after the first treatment period. The treatment does not involve electrical stimulation of the needles.
This add-on code describes each additional 15 minutes of manual acupuncture treatment, without electrical stimulation, performed following the initial 15-minute session (reported with 97810 or 97813). It includes re-insertion of needles and involves direct one-on-one contact with the patient.
Example 1: A patient receives 30 minutes of manual acupuncture without electrical stimulation. 97810 is reported for the initial 15 minutes and 97811 for the subsequent 15 minutes., A patient receives 45 minutes of acupuncture treatment, starting with electrical stimulation for the initial 15 minutes followed by 30 minutes of manual acupuncture without electrical stimulation. 97813 is reported for the first 15 minutes, then 97811 is reported twice for the subsequent 30 minutes of manual acupuncture., A patient receives 15 minutes of acupuncture with electrical stimulation followed by a separate 15-minute session of manual acupuncture later the same day. 97813 is reported for the first treatment, and 97810 (not 97811) is used for the second treatment as it constitutes a new, initial 15-minute session.
Documentation must support the medical necessity of the acupuncture treatment, the total time of one-on-one contact with the patient, and whether electrical stimulation was used.
- Specialties:Acupuncture, Pain Management, Physical Medicine and Rehabilitation, Integrative Medicine
- Place of Service:Office, Independent Clinic, Outpatient Hospital