Will CMS Pay for Dry Needling in 2020

November 4, 2019
Rick Gawenda

On January 1, 2020, there will be 2 new CPT codes to report needle insertion(s) (i.e. dry needling) for qualified healthcare professionals, such as physical therapists, who provide dry needling where allowed by state law and state practice act. Now, just because we have the new CPT codes that describe dry needling does not mean the Medicare program and other insurance carriers have to pay for them. In this article, I will provide the 2 new CPT codes and also tell you if the Medicare program is going to pay for the codes.

The 2 new CPT codes that describe dry needling are as follows:

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Now, what is the payment status for these 2 new codes in calendar year 2020 for the Medicare program. The Centers for Medicare and Medicaid Services (CMS) will

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  1. Hi Rick,

    Do you/will you have any recommended verbiage we can put into a letter for our patients to send in to their insurance companies that will not be paying for the new DN codes in 2020?

  2. Hi Rick, would you be able to provide a source link to CMS where they state this information? Thanks!

    1. If performing dry needling, without injections, in calendar year 2020, CPT codes 20560 and 20561 are the most appropriate CPT codes to bill unless told otherwise by an insurance carrier.

  3. Hello Rick,

    I was on the call regarding dry needling but forgot to ask. I assume with these codes we would attach the corresponding discipline modifiers on the claim form as far as who is dropping the charge correct? Such as GP or GO. Thank you.

    1. CMS did not address this since they are non-covered and did not designate them as sometimes therapy or always therapy CPT codes. In my opinion, I would apply the therapy discipline specific modifier if submitting to CMS.

      1. Thank you Rick, a few more questions after further discussion. Is it recommended to fill out an ABN for patients receiving dry needling? And if so can we type in ahead of time section E and F? And would it be recommended to utilize the ABN even on non-medicare patients. Thank you.

        1. Since dry needling is non-covered by the Medicare program in 2020, an ABN is not mandated to be given to the Medicare beneficiary. I would recommend you issue a voluntary ABN. In addition, the ABN form is only to be used with traditional Medicare beneficiaries and no other insurance carriers, including Medicare Advantage beneficiaries.

  4. If providing the voluntary ABN for dry needling, does this mean that you would still submit the claim with the GX modifier? If so, do you need to wait for Medicare to deny the entire claim/service and then collect cash from the patient or do you collect cash up front? Are you collecting cash just for the dry needling service or for the entire services provided that day along with dry needling since Medicare may deny the entire claim if dry needling is coded on it?

      1. Hi Rick- thanks- sorry I must be missing this on the FAQs – I had read them a few times today- not seeing these specific questions….

      2. This statement from your FAQ seems to be counter intuitive If you aren’t billing the codes to CMS, why go through all of this in the first place and have a voluntary ABN signed? Why not just skip the ABN altogether and bill the codes to CMS and collect from the patient since they are noncovered codes. Or are you saying that we do not need to append the GX for the voluntary ABN but still bill either 20560 or 20561?

          1. The AMA creates CPT codes to describe procedures and interventions. Insurance carriers, including the Medicare program, are not obligated to pay for every CPT code.

  5. Rick,

    We were sent this Medicare update from our biling department. Does this apply to rehab or am I missing something? I couldn’t find anything about this on your site or the APTA which seems usual if it does apply to rehab.
    Transmittal 4544, change request 11691, March 6 2020

    Effective January 21, 2020, Medicare will cover acupuncture and dry needling for patients with chronic low
    back pain. Information on this new coverage determination can be found on the CMS website at:
    Based on this recent coverage determination, we revised the OPPS status indicator and APC assignment for
    the CPT codes describing acupuncture and dry needling services from “E1” (Not paid by Medicare when
    submitted on outpatient claims (any outpatient bill type) to “S” (Paid under OPPS; separate APC payment)
    and “N” (Paid under OPPS; payment is packaged into payment for other services. Therefore, there is no
    separate APC payment.). Table 2, attachment A, lists the long descriptors and status indicators for the codes.

    1. When I read into it futher. I think even though the Dry Needling CPTs are listed, it only applies to acupunture which is not the treatment provided by rehab. Do you agree?

      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:
      o Lasting 12 weeks or longer;
      o nonspecific, in that it has no identifiable systemic cause (i.e., not associated with metastatic, inflammatory, infectious, etc. disease);
      o not associated with surgery; and
      o 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.
      Physicians (as defined in 1861(r)(1)) may furnish acupuncture in accordance with applicable state requirements.
      Physician assistants, nurse practitioners/clinical nurse specialists (as identified in 1861(aa)(5)), and auxiliary personnel may furnish acupuncture if they meet all applicable state requirements and have:
      • A masters or doctoral level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine (ACAOM); and
      • current, full, active, and unrestricted license to practice acupuncture in a State, Territory, or Commonwealth (i.e. Puerto Rico) of the United States, or District of Columbia.
      Auxiliary personnel furnishing acupuncture must be under the appropriate level of supervision of a physician, physician assistant, or nurse practitioner/clinical nurse specialist required by our regulations at 42 CFR §§ 410.26 and 410.27.
      B. Nationally Non-Covered Indications
      All types of acupuncture including dry needling for any condition other than cLBP are non-covered by Medicare.