Does Medicare Now Pay for Dry Needling
Effective January 1, 2020, there were 2 new CPT codes to describe dry needling. They are as follows:
- 20560 – Needle insertion(s) without injection(s), 1 or 2 muscle(s)
- 20561 – Needle insertion(s) without injection(s), 3 or more muscle(s)
Unfortunately, the Centers for Medicare and Medicaid Services (CMS) gave these 2 CPT codes a non-covered status for payment under the Medicare Physician Fee Schedule (MPFS). This meant that if a physical therapist performed dry needling on a Medicare beneficiary who had traditional Medicare as their insurance, CMS would not pay for this service. Since dry needling is non-covered by CMS, this means the Medicare beneficiary would be financially responsible for the cost and the provider of the dry needling service(s) would not be required to issue an advance beneficiary notice of noncoverage (ABN) since an ABN is only issued when the services are normally covered by the Medicare program but under the circumstance, the provider does not think the Medicare program will pay.
On January 21, 2020, CMS issued a decision memo for Acupuncture for Chronic Low Back Pain. In the Decision Summary, CMS states the following:
“The Centers for Medicare & Medicaid Services (CMS) will cover acupuncture for chronic low back pain under section 1862(a)(1)(A) of the Social Security Act. Up to 12 visits in 90 days are covered for Medicare beneficiaries under the following circumstances:
- For the purpose of this decision, chronic low back pain (cLBP) is defined as:
- Lasting 12 weeks or longer;
- nonspecific, in that it has no identifiable systemic cause (i.e., not associated with metastatic, inflammatory, infectious, etc. disease);
- not associated with surgery; and
- not associated with pregnancy.
- An additional eight sessions will be covered for those patients demonstrating an improvement. No more than 20 acupuncture treatments may be administered annually.
- Treatment must be discontinued if the patient is not improving or is regressing”.
This Decision Memo has now created confusion as physical therapists now want to know is dry needling now covered for chronic low back in Calendar Year 2020? The answer is
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I understand that a mandatory ABN is not necessary for DN as it is non-covered service but a voluntary one would be wise. I did read the link for section 50.3.2, from yor FAQ page. Im presuming it is the same ABN form but I do not understand why it would not need to be signed by the patient of staff member? Plaese can you enlighten? Thanks
Because it’s a voluntary ABN and is not required by the Medicare program since the service is never covered.
So, why would you suggest that we use a voluntary ABN?
It’s just an option for providers to voluntarily notify the Medicare beneficiary. You are not required to issue an ABN in this specific situation.
Wanted to verify that auxiliary personnel must meet both the requirements of degree in acupuncture and have unrestricted license? Is physical therapy considered auxiliary personnel?
PT’s can be paid for dry needling under the Medicare program.
Is this a change from the article above?
“The dry needling CPT codes mentioned above are still non-covered under the MPFS and are not payable when provided under a physical therapy plan of care.”
CMS does not pay for the dry needling CPT codes if provided under a PT plan of care.
Do we have to bill 20560/20561 when performing dry needling since we know it is not covered?
That would depend on the insurance carrier and the language in your contract with that insurance carrier.
Could we use CPT 97810/98811 for dry needling?
No!
We are showing that CMS does cover 20560 on the CMS 2021 Physician Fee Schedule. Our compliance department is trying to help us establish a dry needling process. Are you able to provide a source that shows these CPT codes are non-covered?
The reference is this article that states everything.
Some questions on dry needling:
*How should the time spent assessing soft tissue prior to inserting the needle be billed? I attended a billing seminar with another company, and they said this time could be billed as manual. However, once the needle is inserted then it is dry needling.
*Would it ever be appropriate to bill attended e-stim if you are using the dry needle as an electrode? Some staff would prefer to do this for payers that do not cover dry needling (i.e. Medicare/Tricare) to avoid the ABN.
*Are you able to bill dry needling and unattended e-stim at the same time since they are both untimed codes? Are you ever able to bill attended e-stim while needles are inserted?
Your questions would fall under my consulting services. If interested, please email me at info@gawendaseminars.com