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    v1.0.30
    OpenPayerBilling CodesAcupuncture ProceduresCPT cpt-97810-acupuncture-initial-15-minute-treatment
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    CPT 97810: Acupuncture, Initial 15-Minute Needling

    Medicare pays $50 and commercial payers pay $49 on average nationally for this procedure.

    CPT code 97810 describes an initial 15-minute acupuncture treatment using solid, metallic, single-use needles manually manipulated to stimulate anatomical points for pain relief, postoperative and chemotherapy nausea and vomiting, stroke rehabilitation, asthma, addiction, and other conditions; service type: acupuncture procedure; typical site of service: outpatient clinic or office-based therapeutic setting.

    For related coverage guidance, see recent payer policy updates: Clinical Review Criteria Intraoperative Neurophysiological Monitoring (IONM), Remote Electrical Neuromodulation for Migraines (i.e., Nerivio®), Lumbar Microdiscectomy.

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    National Reimbursement Benchmarks

    Across national payers, Medicare averages $49.8 for CPT 97810 while BUCA (average commercial) averages $48.6, placing Medicare marginally above BUCA by $1.2. That closeness suggests commercial managed networks represented by BUCA deliver mean payments very near traditional Medicare for this code, with other commercial payers (Aetna, Blue Cross Blue Shield, Cigna, UnitedHealth Group) generally showing higher mean levels.

    Rate dispersion (P75 minus P25) highlights variability across payers: Aetna’s interquartile spread is $14.5, Blue Cross Blue Shield is $17.0, BUCA is $15.0, Cigna is $33.6, and UnitedHealth Group is $35.0. UnitedHealth Group and Cigna show the widest spreads, indicating more variability in contracted rates, while Aetna and BUCA are the tightest, indicating more compressed commercial rate distributions.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 45-year-old patient presents to an outpatient integrative medicine clinic with a three-month history of mechanical low back pain localized to the lumbar region with intermittent radicular features but no red-flag symptoms. The patient has attempted conservative self-care and a short course of nonsteroidal anti-inflammatory therapy with incomplete relief and requests non-pharmacologic management. The clinician (an acupuncturist or a physician credentialed in acupuncture) performs an initial acupuncture session using solid, metallic, fine, single-use needles, manually manipulated by hand. The initial session includes focused history, brief musculoskeletal exam, point selection targeting lumbar paraspinal and distal points, needle insertion and manual stimulation, and observation for treatment response during a 15-minute direct, one-on-one contact period. Vital signs and any anticoagulation status are reviewed before needling. The visit may occur in an outpatient clinic, ambulatory care center, or an integrative medicine practice. Documentation includes start and stop times for the 15-minute acupuncture service, the number and locations of needles, patient tolerance, informed consent for acupuncture, and the primary diagnosis M54.5 (low back pain). If additional 15-minute units are provided during the same encounter, 97811 is reported for each additional unit.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    97811

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    24Modifier 24 denotes an unrelated evaluation and management (E/M) service performed by the same physician or qualified healthcare professional during a postoperative global period. Per CPT guidance,…- Use modifier 24 when you report an evaluation and management (E/M) service performed by the same physician or same-specialty group during a procedure’s postoperative global period that is unrelated…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    171100000X
    208D00000X
    208100000X
    224ZL0004X
    173000000X
    1223P0221X
    2279P1006X
    163WF0300X

    Related Payer Policy Updates

    Specialty: Neurology/Neurosurgery1 / 3

    10 rows

    PolicyPayerEffective Date
    Clinical Review Criteria Intraoperative Neurophysiological Monitoring (IONM)Kaiser Permanente2027-01-01
    Remote Electrical Neuromodulation for Migraines (i.e., Nerivio®)bcbsvermont2026-11-01
    Lumbar Microdiscectomyuniverahealthcare2026-10-15
    Artificial Cervical Intervertebral Discuniverahealthcare2026-10-15
    Lumbar Decompressionuniverahealthcare2026-10-15
    Responsive Neurostimulation for Focal EpilepsyPremera Bluecross2026-10-14
    Intraoperative MonitoringProvidence Health Plan2026-10-01
    Intraoperative MonitoringProvidence Health Plan2026-10-01
    High-Intensity Focused UltrasoundMass General Brigham Health Plan2026-10-01
    Vagal Nerve StimulationAmbetter Nevada2026-10-01

    Related Codes

    CPT-97811-ACUPUNCTURE-ADDITIONAL-15-MINUTE-CONTINUATION

    CPT 97811: Acupuncture, Each Additional 15 Minutes

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

    CPT 97813: Electroacupuncture, 15-Minute Initial Treatment

    CPT-97814-ACUPUNCTURE-ELECTRICAL-STIMULATION-ADDITIONAL-15-MIN

    CPT 97814: Acupuncture with Electrical Stimulation, Additional 15 Minutes

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

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

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

    CPT 98003: New Patient Telehealth E/M, High Complexity, 60+ Minutes

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

    CPT 98005: Established Patient Telehealth E/M, Low MDM, ≥20 Minutes

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

    CPT 98008: New Patient Audio-Only Evaluation and Management

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

    CPT 98016: Virtual Check‑in for Established Patient, 5–10 Minutes

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    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.

    Acupuncture procedures; each additional 15 minutes of personal one-on-one contact with the patient, without electrical stimulation
    Reported for each additional 15-minute increment of acupuncture treatment after the initial 97810 unit

    | 99213 | Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes | May be reported separately with modifier 25 when a distinct E/M is provided the same day as 97810

    | 99203 | Office or other outpatient visit for the evaluation and management of a new patient, typically 30 minutes | May be reported for initial consultations that include medical decision-making distinct from the acupuncture treatment

    | 97001 | Physical therapy evaluation (Medicare code set) | May occur in the same episode of care for low back pain; not billed by acupuncturist unless separately provided

    | 97012 | Traction, mechanical | Therapeutic modalities that may be performed in multimodal rehabilitation programs alongside acupuncture