Dry Needling and Medicare: February 2022 Update
For those physical therapists (PTs) that perform dry needling on Medicare beneficiaries, they understand that the Medicare program does not reimburse PTs for dry needling when billing CPT codes 20560 and 20561. What has been confusing is must the PT provider issue a mandatory advance beneficiary notice of noncoverage (ABN) to the Medicare beneficiary or is the ABN an optional ABN to provide to the Medicare beneficiary? This question has now apparently been answered by the Centers for Medicare and Medicaid Services (CMS).
According to clarification received by
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Can you give any updates on the Managed Medicare plans coverage for Dry Needling?
Hummana (in NC) told us the Dry needling codes are “valid and billable” and “do not require pre- authorization” but does this mean it will get paid??
Thanks!
That would be insurance carrier specific and you would need to contact each insurance carrier and/or review any of their therapy policies that they may have online.
Do you need to submit FDN CPT codes on claims for commercial pts?
That would be insurance carrier specific.
Does this apply to advantage plans?
The ABN is only used with traditional Medicare beneficiaries.
if you are doing dry needling and using an e-stim device through the needle, can you bill a NM re ed for the muscle fiber being reset by the stimulation? If not NM re ed, could you use unattended estim code?
Please read my Dry Needling FAQs for the answer to your question. https://gawendaseminars.com/faq/faq-dry-needling/
We have a flat cash based price for procedures that are not covered/never billed to insurance plans. If we bill Medicare our regular dry needling fee and it is denied, are we able to provide a discount to the patient since Medicare did not pay or does this become a compliance issue like waiving a copay or deductible would?
You would place the estimated cost for the DN on the ABn form.
That makes sense, thank you.
Rick,
I see where you linked a coverage memo for acupuncture. I think it’s important that you distinguish that dry needling and acupuncture are indeed separate treatment options and should not be considered the same when billing or viewing any other compliancy issue for that matter.
From CMS: All types of acupuncture including dry needling for any condition other than cLBP are non-covered by Medicare.
Would an ABN form need to be completed each time the patient gets dry needling OR would one ABN form suffice for a certain timeframe?
In Section D, you can put a frequency and duration that the ABN would cover.
Rick, if a patient chooses option 2 on the ABN, then we will not have to bill the CPT code with the GA modifier to Medicare, and we can go ahead and collect our normal cash payment at time of service, is that how you interpret that?
☐ OPTION 2. I want the (D)______ listed above, but do not bill Medicare. You may ask to be
paid now as I am responsible for payment. I cannot appeal if Medicare is not billed.
Correct
So is BCBS following suit with Medicare?
You would need to check with your BCBS plan.
What if we offer dry needling as a cash only service across the board?
CMS is now telling you the process for DN and you would need to follow that.