Fwd: [AACBoard-AnnounceList] CPT SUMMARY

February 12, 2005

It is too early to tell how things will look after the new CPT codes get set

in

place.

>>>The new CPT codes basically mean you will receive $17 per half hour of

>>>one to one patient contact. That would also mean that most of us would

>>>probably have to bill illegally for more than one patient for an half

>>>hour period. How can you run an office on $37 per hour income.

>>>Unfortunately this is another example of the short sighted actions of

>>>many in our profession

February 12, 2005

Most pay on the 80th

percentile.

>>>>>Not true. The new codes have a time value, that means they will not

>>>>>look at customary charges but have a fixed formula to calculate

>>>>>payments. As I said before it is $17.5 for half hour electroacupuncture

>>>>>of one to one contact. That is you may only see one patient during the

>>>>>half hour. You cannot routinely add an office charge to this. So in

>>>>>effect they want you to work for $35 per hour.

February 12, 2005

" Dr. Phranque " <wrighttothepoint wrote:

The new CPT codes for acupuncture became effective January 1, 2005 and by

now, all insurance companies are up-to-date with using them. Workers Comp

is still using the old codes, but for other insurances (including auto

accidents) the new codes must be used to be reimbursed by insurance.

I have been getting a lot of calls with questions concerning the new CPT

codes, lately, most of them concern what to charge. I, personally, do not

bill insurance and therefore am extremely ignorant of its workings. So, I

went to our Insurance Committee Co-Chair and newly elected Board Member Mark

Evans for some answers. The following is his summary of the new codes, with

guidelines for billing. If you have other questions about billing, please

contact Mark (contact info below) or Drew Henderson (President and Co-chair

of the insurance committee - 303-440-7004).

I hope this information is helpful!

-Phranque-

CPT Codes for 2005

-----------------------

Effective January 1, 2005 the CPT codes for acupuncture have changed. In the

past 97780 was the code for an acupuncture visit, 97781 was the code for an

acupuncture visit with electrical stimulation. Insurance companies decided

what

to pay based on a percentile of customary services. Most pay on the 80th

percentile.

Here is an example of what that means. If I charge $60 a visit, Phranque

charges

$50 a visit, and Phil charges $100 per visit the 80th percentile will be

around

$85 per visit. This is the maximum an insurance company would pay for

acupuncture services. Charges in excess of this would be reduced as is

“reasonable and customaryE

------

So what are the new codes?

---

97810 is the new code for acupuncture with the first 15 minutes of time

spent

with the client.

97811 is used for each additional 15 minutes with the client.

97813 is the new code for acupuncture with the first 15 minutes of time

spent

with the client with the use of electrical stimulation.

97814 is used for each additional 15 minutes with the client with the use of

electrical stimulation.

To be within the law you must be in the room and attending to the patient in

some capacity to bill for each 15 minute increment.

If Judy does Worsley School Five Elements Acupuncture and spends 60 minutes

of

time with the patient, she can bill 97810 one time and 97811 three times. If

Mark spends 3 minutes with a patient he bills 97810 only.

--------------

So now, what do we charge for our services?

--------------

On average acupuncturists bill between $40 and $120 for each treatment. On

average we spend between 15 and 45 minutes in the room with the client. So

accept the below as a sample fee schedule:

97810 $55

97811 $55

97813 $65

97814 $65

Accept this example. Lets say we all spend 30 minutes with the patient not

counting the amount of time the patient is unattended. We would bill one

unit of

97810 and one unit of 97811 totaling $110. Now this sounds a little high

especially considering the earlier example of $85 being in the 80th

percentile.

This is a relative maximum, consider it a safety net to cover you when the

insurance company has a different pricing structure in mind. You may set

your

rates lower if you like.

-------------------------

Conclusion?

-----------------------------

It is too early to tell how things will look after the new CPT codes get set

in

place. This is just a preliminary guideline. Look for updates from your

Acupuncture Association of Colorado. We are here to serve you. Feel free to

contact me with any questions or concerns.

-Mark Evans

Insurance Committee

AAC

720-353-0893

drmark

" Life is either a daring adventure or nothing. Security does not exist in

nature, nor do the children of men as a whole experience it. Avoiding danger is

no safer in the long run than exposure. " - Helen Keller

Meet the all-new My – Try it today!

February 17, 2005

Nicole

READ the updated ABC Codes. It is based upon time with a much better

relative value of 1.2.

Go to _www.alternativelink.com_ (http://www.alternativelink.com) and read.

Also SEE the current article on-line at Acupuncture Today written by the CEO

of Alternative Link Synthia Molina.

Richard

In a message dated 02/17/05 12:10:01 PM Central Standard Time,

nicolehohmann writes:

Where do you get the $17 per half hour? Is that what you have been

reimbursed for billing 97810 plus 97811? If so , that is abismal. I

am in a cash practice, but worried about the way our profession is

going toward managed care.

I think for patients especially medicare it would be good to get

acupuncture coverage, but not necessarily good for us as a profession

to turn us into needle inserting machines. One way to resist I think

is to resist having to be in an insurance network so that you agree

to discounted charges and to write off the difference (meaning agree

to not collect from the patient any more than what insurance covers).

I don't see how ABC codes are better in that acupuncture is billed

per number of needles inserted. So Korean 4 needle treatments are

less valuable regardless of contact time with the patient?

If anyone has ABC reimbursement info I would be interested to see it..

Nicole Hohmann

February 17, 2005

Another reason to be using the ABC Codes.

Richard

In a message dated 02/17/05 3:42:22 PM Central Standard Time,

alonmarcus writes:

>>>>>>Interestingly my partner was just told by ASHP to bill 97813 and two

97814 to get paid their $40 rate which they used to give for 97780. That means

that they want you to lie very time unless you see one patient per 45

minuets.

February 17, 2005

None can legally deny.

It doesn't matter what others experience may be.....just start billing them!

Richard

>>>>Richard can you tell me of an insurance company that excepts that ABC

codes

February 17, 2005

Alon,