Summary & Overview
CPT 97814: Acupuncture with Electrical Stimulation, 15 Minutes
CPT code 97814 is a nationally recognized billing code for acupuncture services with electrical stimulation, delivered in 15-minute increments of direct patient contact. This code is significant for providers offering integrative pain management and musculoskeletal therapies, as it is widely accepted by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The code is commonly used in office settings and is relevant for practitioners such as acupuncturists, general practice physicians, and physical medicine & rehabilitation specialists.
The publication provides a comprehensive overview of payer coverage, clinical indications, and billing practices for 97814. Readers will gain insights into typical diagnoses associated with this code, such as low back pain (M54.5), fibromyalgia (M79.7), headache (R51), and knee pain (M25.561, M25.562). The summary also covers related CPT codes for acupuncture procedures, common modifiers like 59 and 76, and associated provider taxonomies. Policy updates and benchmarks are included to inform stakeholders about current trends in reimbursement and utilization.
This resource is designed for healthcare professionals, billing specialists, and policy analysts seeking up-to-date information on acupuncture coding, payer policies, and clinical context for CPT code 97814.
CPT Code Overview
CPT code 97814 describes acupuncture services involving one or more needles with electrical stimulation, provided for each 15 minutes of personal one-on-one contact with the patient. This procedure is typically performed in an office setting (Place of Service 11) and is used to address a range of pain and musculoskeletal conditions. The code is part of a series of acupuncture codes that distinguish between initial and subsequent sessions, as well as the use of electrical stimulation. Acupuncture with electrical stimulation is recognized for its potential therapeutic benefits in managing chronic pain and other health concerns.
Clinical & Coding Specifications
Clinical Context
A patient presents to the office with chronic low back pain. After evaluation, the provider determines that acupuncture with electrical stimulation may help manage the patient's symptoms. The provider, who may be an acupuncturist, general practitioner, or physical medicine & rehabilitation physician, performs acupuncture using one or more needles and applies electrical stimulation. The procedure involves personal one-on-one contact with the patient for 15 minutes. This service is typically performed in an office setting and may be repeated as clinically indicated.
Coding Specifications
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Modifiers:
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59: Distinct Procedural Service. Used when acupuncture with electrical stimulation is performed as a separate and distinct service from other procedures on the same day. - Modifier
76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. Used when the same acupuncture service is repeated by the same provider.
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Provider Taxonomies:
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