- Acupuncture is billed with four time-based CPT codes: 97810 / 97811 (without electrical stimulation) and 97813 / 97814 (with electrical stimulation).
- Each code represents a 15-minute increment of personal one-on-one contact; the “initial” codes (97810, 97813) are billed only once per visit, with add-on codes for additional units.
- Medicare covers acupuncture only for chronic low back pain (up to 12 visits in 90 days, with conditions) — most other indications are non-covered.
- Time documentation, the correct add-on sequencing, and modifiers (such as GA, GY, or 59) are the most common acupuncture denial triggers.
Acupuncture has moved into the mainstream of integrative care, but its billing rules trip up even experienced practices. The codes are time-based, the initial-versus-additional logic is unforgiving, and Medicare's coverage is far narrower than many patients expect. Getting paid for acupuncture in 2026 comes down to coding the right unit, documenting face-to-face time, and knowing exactly when a service is covered. This guide breaks it all down.
Acupuncture CPT codes for 2026
Acupuncture is reported with four CPT codes that hinge on two variables: whether electrical stimulation is used, and whether the unit is the initial 15 minutes or an additional 15 minutes. Each unit requires re-insertion of needles for the additional code.
| CPT Code | Description | Billing rule |
|---|---|---|
| 97810 | Acupuncture, 1+ needles, without electrical stimulation — initial 15 min | Bill once per day; initial code without e-stim |
| 97811 | Acupuncture, without electrical stimulation — each additional 15 min, with re-insertion | Add-on to 97810; report per additional 15-min unit |
| 97813 | Acupuncture, 1+ needles, with electrical stimulation — initial 15 min | Bill once per day; initial code with e-stim |
| 97814 | Acupuncture, with electrical stimulation — each additional 15 min, with re-insertion | Add-on; report per additional 15-min unit |
The 15-minute time rule
Acupuncture codes are based on personal one-on-one contact with the patient, not total appointment length. The time counts the practitioner's face-to-face time, and the needle-retention period (when the provider is not present) does not count toward the timed units. To bill an additional unit, the documentation must support at least the next increment of personal contact and re-insertion of needles.
- Document start and end of face-to-face time for each set of needles.
- Note electrical stimulation when used, to justify 97813/97814 over 97810/97811.
- Record re-insertion for each add-on unit billed.
- Tie the service to the diagnosis and treatment plan to support medical necessity.
Medicare acupuncture coverage rules
This is where most acupuncture billing goes wrong. Medicare covers acupuncture only for chronic low back pain (cLBP) — defined as lasting 12 weeks or longer, with no identifiable systemic cause. Key parameters:
- Up to 12 visits in 90 days are covered for chronic low back pain.
- An additional 8 visits may be covered if the patient demonstrates improvement, for a maximum of 20 treatments per year.
- Treatment is discontinued if the patient does not improve or worsens.
- Acupuncture for any other condition is not covered by Medicare.
Because most acupuncture indications fall outside Medicare coverage, modifiers matter. When a service is statutorily non-covered, an ABN (Advance Beneficiary Notice) and the appropriate modifier (such as GA or GY) signal patient liability and prevent improper billing. For commercial payers, always verify benefits first — a disciplined verification of benefits process confirms acupuncture coverage and visit limits before the first needle.
Modifiers used in acupuncture billing
| Modifier | When to use |
|---|---|
| GA | ABN on file; expected to be denied as not medically necessary, patient may be billed. |
| GY | Service is statutorily excluded / not a Medicare benefit. |
| GZ | Expected denial, no ABN on file (provider liability). |
| 59 / XU | Distinct procedural service, when acupuncture is separate from another same-day service and bundling edits apply. |
Always confirm payer-specific modifier policy — commercial plans and Medicare Advantage may differ from traditional Medicare.
Top acupuncture denial reasons
| # | Denial reason | How to prevent it |
|---|---|---|
| 1 | Service not covered (non-cLBP indication on Medicare) | Verify coverage; use ABN + GA/GY for non-covered services. |
| 2 | Time/units not supported by documentation | Document face-to-face time and re-insertion for each unit. |
| 3 | Two initial codes billed in one visit | Bill only one initial code (97810 or 97813) per day. |
| 4 | Exceeded Medicare visit limits | Track the 12-in-90-days and 20-per-year caps; document improvement. |
| 5 | Missing/incorrect modifier | Apply GA, GY, GZ, or 59/XU per payer and ABN status. |
When denials happen, a structured denial management process recovers revenue and prevents repeat errors. For broader coding context, the CPT complete guide explains how time-based and add-on codes work across specialties, and our urgent care billing guidelines follow the same payer-rule-first approach.
Frequently asked questions
Acupuncture is billed with four CPT codes: 97810 (initial 15 minutes without electrical stimulation), 97811 (each additional 15 minutes without e-stim), 97813 (initial 15 minutes with electrical stimulation), and 97814 (each additional 15 minutes with e-stim). The initial codes are billed once per visit and the add-on codes capture additional time.
Medicare covers acupuncture only for chronic low back pain lasting 12 weeks or longer with no identifiable systemic cause. Coverage allows up to 12 visits in 90 days, with an additional 8 visits (20 per year maximum) if the patient improves. Acupuncture for any other condition is not covered by Medicare.
Acupuncture codes are based on 15-minute increments of personal, face-to-face one-on-one contact with the patient — not the total appointment time. The needle-retention period without the provider present does not count. Each additional unit also requires re-insertion of needles and supporting documentation.
No. Only one initial acupuncture code may be reported per visit. If both non-stimulated and electrically stimulated acupuncture are performed, you bill a single initial code and capture the remaining time with the appropriate add-on code (97811 or 97814).
Common modifiers include GA (ABN on file, expected denial, patient may be billed), GY (statutorily non-covered service), GZ (expected denial, no ABN), and 59 or XU (distinct procedural service when bundling edits apply). Always confirm payer-specific modifier policy before submitting.