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Acupuncture Services 97810 – 97814 Remain Compensable

Medical billing & collections experts for over 25 years. We stay up to date on all CPT coding changes, including those for acupuncture. (949) 863-0022

On 07/18/2018 the DWC issued information reminding workers’ comp payers that acupuncture continues to remain within the definition of “medical treatment” under Labor Code 4600 and employers and or their insurers MUST PAY for it if it is deemed medically necessary.

At MBC Systems, we specialize in California Labor Codes and workers’ compensation billing. We know that navigating the complexities–and conflicting data–regarding workers’ comp codes can end up costing physicians money. We hope to clarify the ambiguities so you aren’t leaving money on the table.

Medicare/Medicaid’s latest version to the “Medically Unlikely Edits” CMS included acupuncture codes for the first time BUT listed them with a value of ZERO. Any bills that are denied based on this latest update should be appealed within 90 days citing CCR Section 9789.12.13 for proper reimbursement along with your authorization to treat the injured worker.

California Code of Regulations (CCR) Section 9789.12.13 states:

9789.12.13 Correct Coding Initiative (a) The National Correct Coding Initiative Edits (“NCCI”) adopted by the CMS shall apply to payments for medical services under the Physician Fee Schedule. Except where payment ground rules differ from the Medicare ground rules, claims administrators shall apply the NCCI physician coding edits and medically unlikely edits to bills to determine appropriate payment.

There is grounds for confusion here, as a conflict between the Centers for Medicare and Medicaid Services’ (CMS) Medically Unlikely Edits (MUE) and California’s Official Medical Fee Schedule (OMFS) for workers’ comp services is leaving many payers unclear. In this case, however, the OMFS rules designating codes 97810-97814 reimbursable take precedence.

If this isn’t the first time coding complexities have made your medical billing an exhausting and expensive chore, consider outsourcing to a medical billing and collections agency. At MBC Systems, we can simplify your medical office management, improve your patients’ experiences, maintain your online reputation, and improve your cash flow. Call us at (949) 863-0022 to learn more.