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.

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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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CPT 97810: Acupuncture, Initial 15-Minute Needling

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

Customize your policy alerts

Sign up for cpt 97810 policy alerts

Get alerted when payer policies referencing 97810 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

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 Code	Description	Relationship to This Procedure
`97811`	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

Related Modifiers

8 rows

Modifier	Description	When to Use
25	CPT 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.,…
59	Modifier 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…
76	Modifier -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…
77	Modifier 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…
52	Modifier ‑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…
53	Modifier 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…
22	Modifier –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…
24	Modifier 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	Specialty	Notes
171100000X	Acupuncturist	An acupuncturist is a person who performs ancient therapy for alleviation of pain, anesthesia and treatment of some diseases. Acupuncturists use long,…
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
208100000X	Physical Medicine & Rehabilitation Physician	Physical medicine and rehabilitation, also referred to as rehabilitation medicine, is the medical specialty concerned with diagnosing, evaluating, and…
224ZL0004X	Low Vision Occupational Therapy Assistant	Occupational therapy assistants contribute to the completion of an individualized occupational therapy low-vision evaluation under the direction and s…
173000000X	Legal Medicine	The specialty areas of medicine concerned with matters of, and relations with, substantive law and legal institutions; such as the conduct of medical …
1223P0221X	Pediatric Dentistry	An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through ado…
2279P1006X	Pulmonary Function Technologist Registered Respiratory Therapist	An individual who is trained and qualified to perform pulmonary diagnostic tests. In the course of conducting these tests, the Pulmonary Function Tec…
163WF0300X	Flight Registered Nurse	Nursing Service Providers · Registered Nurse

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.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.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.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.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97811`	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

| 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

Related Modifiers

8 rows

Modifier	Description	When to Use
25	CPT 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.,…
59	Modifier 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…
76	Modifier -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…
77	Modifier 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…
52	Modifier ‑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…
53	Modifier 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…
22	Modifier –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…
24	Modifier 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	Specialty	Notes
171100000X	Acupuncturist	An acupuncturist is a person who performs ancient therapy for alleviation of pain, anesthesia and treatment of some diseases. Acupuncturists use long,…
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
208100000X	Physical Medicine & Rehabilitation Physician	Physical medicine and rehabilitation, also referred to as rehabilitation medicine, is the medical specialty concerned with diagnosing, evaluating, and…
224ZL0004X	Low Vision Occupational Therapy Assistant	Occupational therapy assistants contribute to the completion of an individualized occupational therapy low-vision evaluation under the direction and s…
173000000X	Legal Medicine	The specialty areas of medicine concerned with matters of, and relations with, substantive law and legal institutions; such as the conduct of medical …
1223P0221X	Pediatric Dentistry	An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through ado…
2279P1006X	Pulmonary Function Technologist Registered Respiratory Therapist	An individual who is trained and qualified to perform pulmonary diagnostic tests. In the course of conducting these tests, the Pulmonary Function Tec…
163WF0300X	Flight Registered Nurse	Nursing Service Providers · Registered Nurse

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.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.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.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.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 97810: Acupuncture, Initial 15-Minute Needling

Sign up for cpt 97810 policy alerts

National Reimbursement Benchmarks

OpenPayer

CPT 97810: Acupuncture, Initial 15-Minute Needling

Sign up for cpt 97810 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

CPT 97810: Acupuncture, Initial 15-Minute Needling

Sign up for cpt 97810 policy alerts

National Reimbursement Benchmarks

CPT 97810: Acupuncture, Initial 15-Minute Needling

Sign up for cpt 97810 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does CPT 97810 describe and for which clinical indications is it used?

When should 97811 be reported in relation to 97810?

Which modifiers are relevant when billing 97810 and when are they used?

What does the reimbursement benchmark data show for 97810 across payers?

What documentation elements are highlighted for a 97810 acupuncture visit?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does CPT 97810 describe and for which clinical indications is it used?

When should 97811 be reported in relation to 97810?

Which modifiers are relevant when billing 97810 and when are they used?

What does the reimbursement benchmark data show for 97810 across payers?

What documentation elements are highlighted for a 97810 acupuncture visit?

References