Acupuncture for Chronic Low Back Pain
Photo: Pexels – Alma Thai
How does acupuncture help chronic low back pain? Acupuncture alleviates pain by stimulating nerve endings to release natural painkillers like endorphins, reducing inflammation through vagus nerve activation, enhancing blood flow for tissue repair, and shifting the nervous system from a stress response to a restorative state.
What is the difference between acupuncture and dry needling?
Acupuncture and dry needling both use thin needles but differ in approach and coverage. Acupuncture is based on Traditional Chinese Medicine and targets energy flow (Qi) through specific acupoints, while dry needling is a Western technique that treats muscle trigger points to relieve pain. Acupuncture is often performed by licensed acupuncturists, whereas dry needling is typically done by physical therapists.
For billing, acupuncture may be reimbursed by Medicare and some commercial payers, but only under strict conditions. Dry needling is usually not covered by Medicare and is often denied by insurers, even when billed with CPT codes 20560 or 20561. Documentation must clearly distinguish the two services to avoid denials, especially when both are performed in the same session.
CMS Coverage Criteria
CMS defines cLBP as:
-Lasting 12 weeks or longer
-Nonspecific, in that it has no identifiable systemic cause, such as being associated with metastatic, inflammatory, or infectious disease
-Not associated with surgery
-Not associated with pregnancy
Treatment must be discontinued if the patient is not improving or is regressing
CPT Codes
97810 – Acupuncture, 1 or more needles; w/o electrical stimulation, initial 15” of personal one-on-one contact with the patient.
97811 – ; w/o electrical stimulation, each additional 15” of personal one-on-one contact with the patient, with insertion of needle(s). (Report with 97810 or 97813)
97813 – Acupuncture, 1 or more needles; with electrical stimulation, initial 15” of personal one-on-one contact with the patient.
97814 – ; with electrical stimulation, each additional 15” of personal one-on-one contact with the patient, with insertion of needle(s). (Report with 97810 or 97813)
Note: 15” increments are for face-to-face personal contact with the patient, not the duration of acupuncture needle(s) placement.
Coding Tip: You may only report ONE base code modality. Add-on codes may be used with either base code.
Documentation Requirements for Acupuncture
To support reimbursement, documentation must:
- Establish Medical Necessity
- Clearly state the diagnosis or condition being treated (e.g., chronic low back pain).
- Include a treatment plan with frequency, duration, and expected outcomes.
- Detail the Service Provided
- Specify the acupuncture points used and the modality (manual vs. electrical stimulation).
- Include start and stop times for time-based services.
- Document the number of needles, duration retained, and patient response.
- Include Proper Signatures
- Must be signed and dated by the licensed provider.
- Electronic signatures should include a timestamp and provider credentials.
- Stamped signatures are not acceptable.
- Ensure Legibility and Specificity
- Avoid cloned or templated notes that make all visits look identical.
- Each entry must be patient-specific and reflect the actual encounter.
- Timeliness
- Documentation should be completed within 24–48 hours of the service.
- Late entries must be clearly labeled as addendums with date, time, and reason.
- Support Coding and Billing
- CPT codes (e.g., 97810, 97811) must match the documented service.
- Documentation must justify the level of service and any modifiers used.
Resources:
MLN Matters: NCD 30.3.3 – Acupuncture for Chronic Low Back Pain