Dry Needling Questions and Answers
Dry needling CPT codes were created by the American Medical Association and became effective with dates of service on and after January 1, 2020. Even though the CPT codes have been effective for over 2.5 years, many physical therapists still do not have a solid understanding of the CPT codes and billing and payment regulations concerning dry needling. In this article, I will answer the following questions:
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Good morning, Rick. We bill Medicare on a UB04. We have been trying to bill Medicare for dry needling using the ABN modifier so we can get a crossover to bill Medicaid which does pay for dry needling. Our claims keep getting kicked back stating we are not using the correct revenue code. We have tried 0420 and 0429 without success. Is anyone able to bill on a UB for dry needling successfully?
I just read this article at https://gawendaseminars.com/dry-needling-questions-and-answers/
I just paid for a subscription to get this type of content, but I am now confused even more.
CMS says in order to bill a Medicare beneficiary for dry needling we must:
1. Provide a mandatory ABN to the patient.
2. Include the appropriate code on the claim — 20560 or 20561.
3. Append the claim with the GA modifier — that’s the modifier indicating that you expect Medicare to deny the services, and you have a signed ABN on file.
But your answer says we don’t have to issue an ABN. Which one is correct?
Since CMS is going to do the audit, we should follow their guidelines.
I see CMS’s reasoning. If a beneficiary inquires about dry needling and is told by insurance that it is covered for lower back pain they figure it is covered. But they don’t understand that is must be provided by a certain type of provider. So the physical therapist must issue the ABN to avoid the confusion.
Can you clarify this?
You will need to decide based on the article. CMS has never released nationally what APTA says CMS told them and the MACs have no instructions from CMS.
Thanks, Rick. I’m trying to stay updated with all of the changes. Back in Feb, the rules had changed so that a mandatory ABN was required (https://gawendaseminars.com/dry-needling-and-medicare-february-2022-update/). To confirm, the ABN is back to being voluntary?
You will need to decide based on the article. CMS has never released nationally what APTA says CMS told them.
What is your opinion regarding billing electrical stimulation along with dry needling? I understand it would not be appropriate to bill G0283 or 97032 in place of the dry needling codes (20560 and 20561). Could you bill 20560/20561 for the time of inserting the needles AND also bill G0283/97032 for the time the electrical stimulation is applied?
If the electrical stimulation is applied through the needles, I would say no.
I have tried to find more information and clarity on why you wouldn’t bill electrical stimulation if you are providing that service, especially for an insurance that does reimburse for dry needling. If I perform manual therapy and then place pads on the tissue and do electrical stimulation I would bill for both so why would it be different if I perform needle insertion, manipulate the needle, and then use clips on the needles to perform electrical stimulation? I want to make sure we are capturing all of the charges we are allowed to in the appropriate manner. Thank you.
The e-stim is done in conjunction with the dry needling (DN) by inserting the needle into the patient and DN is not covered. Since not covered for Medicare, patient is responsible for your charges. Charge appropriately for what you feel your services are worth.
What about payers that do cover dry needling? Is it appropriate to bill 20560/20561 with either the time (97032) or untimed (97014/G0283) electrical stimulation code? I’m looking at this from the rules on billing untimed codes concurrently with another timed or untimed code.
You would have to ask yourself why are you doing what you are doing, what is your intent of the intervention, and what does your documentation support.
I was curious if anyone knows if an occupational therapist trained/certified in dry needling can bill for dry needling (in MI if it matters)? Can OTs bill cash for it?
Whether or not an OT can perform dry needling would be determined by your practice act in the state that you practice in.
Good morning, are there any updates for 2023 regarding Medicare reimbursement for 20560 and 20561?
No change from 2022.
Good afternoon,
are there any updates for 2024 regarding Medicare reimbursement for 20560 and 20561?
Nothing is changing with these codes.