CPT 97810 Acupuncture Benchmarks & Reimbursement | OpenPayer

Summary & Overview

CPT 97810: Acupuncture, Initial 15 Minutes Without Electrical Stimulation

CPT code 97810 is a nationally recognized billing code for acupuncture procedures, specifically for the initial 15 minutes of one-on-one contact with a patient using one or more needles without electrical stimulation. This code is significant as acupuncture continues to gain acceptance as a complementary therapy for conditions such as low back pain, and is increasingly covered by major health insurers. The publication examines coverage and policy benchmarks for CPT 97810 across key payers, including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will gain insight into payer coverage trends, clinical context, and policy updates relevant to acupuncture services. The analysis includes information on typical sites of service, common modifiers, and associated provider taxonomies. Additionally, the publication highlights related codes and diagnoses, providing a comprehensive overview for stakeholders interested in medical billing, reimbursement, and clinical utilization of acupuncture procedures. This summary serves as a resource for understanding how CPT 97810 is positioned within the broader landscape of medicine services and procedures.

AetnaBlue Cross Blue ShieldCigna HealthMedicareUnitedHealthcareCPT 97810acupuncturemedicine servicesoffice visitmedical billingprocedure codingclinical benchmarkspolicy updatesreimbursementlow back pain

CPT Code Overview

CPT code 97810 represents an acupuncture procedure involving one or more needles, performed without electrical stimulation. This code is used for the initial 15 minutes of personal, one-on-one contact between the provider and the patient. Acupuncture procedures fall under the broader category of Medicine Services and Procedures. The typical site of service for this procedure is an office setting (Place of Service 11).

Clinical & Coding Specifications

Clinical Context

A patient presents to the office with complaints of low back pain. After an evaluation, the provider determines that acupuncture is an appropriate treatment modality. The provider, who may be an acupuncturist, general practice physician, or physical medicine & rehabilitation physician, performs acupuncture using one or more needles without electrical stimulation. The session consists of the initial 15 minutes of personal one-on-one contact with the patient, during which the provider assesses the patient's response and adjusts the treatment as needed. This procedure is documented and coded as 97810.

Coding Specifications

Modifiers:

Modifier Code	Description
`59`	Distinct Procedural Service: Used when acupuncture is performed as a separate and distinct service from other procedures on the same day.
`76`	Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Used when the same provider repeats the acupuncture procedure during the same encounter or on the same day.

National Reimbursement Benchmarks

For CPT code 97810, the national mean rate for Medicare is $49.75, while the average commercial benchmark (BUCA) is $45.63. This places Medicare slightly above the commercial average, with UnitedHealth Group and Cigna showing even higher mean rates among commercial payers.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare exhibits the tightest range at $4.00, indicating relatively consistent reimbursement rates. In contrast, UnitedHealth Group has the widest range at $34.78, followed by Cigna at $28.50, reflecting greater variability in commercial payer rates.

The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.

National Mean Rates for CPT 97810 by Payer

CPT 97811: Acupuncture, Manual Needling — Additional 15 Minutes

97814-ACUPUNCTURE-1-OR-MORE-NEEDLES-WITH-ELECTRICAL-STIMULATION

CPT 97814: Acupuncture with Electrical Stimulation, 15 Minutes

CPT-98008-NEW-PATIENT-AUDIO-ONLY-EVALUATION-AND-MANAGEMENT

CPT 98008: New Patient Audio-Only Evaluation and Management

CPT-97813-ELECTROACUPUNCTURE-INITIAL-15-MINUTE-TREATMENT

CPT 97813: Electroacupuncture, Initial 15-Minute Treatment

CPT-98003-TELEMEDICINE-NEW-PATIENT-EVALUATION-HIGH-COMPLEXITY-60MIN

CPT 98003: Telehealth New-Patient Evaluation, High Complexity

CPT-98005-ESTABLISHED-PATIENT-TELEHEALTH-EVALUATION-20-MINUTES

CPT 98005: Established Patient Telehealth E/M Visit, Low Complexity

CPT-98002-NEW-PATIENT-TELEHEALTH-EVALUATION-MODERATE-COMPLEXITY

CPT 98002: New Patient Telehealth E/M Visit, Moderate Complexity

CPT-98016-VIRTUAL-BRIEF-EVALUATION-ESTABLISHED-PATIENT

CPT 98016: Brief Virtual Evaluation for Established Patients

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Taxonomy Code	Specialty
`171100000X`	Acupuncturist
`208D00000X`	General Practice Physician
`208100000X`	Physical Medicine & Rehabilitation Physician

OpenPayer

Summary & Overview

CPT 97810: Acupuncture, Initial 15 Minutes Without Electrical Stimulation

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

National Reimbursement Benchmarks

Related Codes

Related Diagnoses

Related CPT Codes

National Reimbursement Benchmarks

Related Codes