Acupuncture practice management and clinic software

Two rooms running, one practitioner

A typical acupuncture day overlaps treatments: needles go in for one patient while the practitioner moves to the next room. A calendar that only knows practitioners double-books the rooms, and one that only knows rooms hides the fact that the same person is due in both.

Medicare pays for one diagnosis, and not to you directly

Medicare Part B covers acupuncture, dry needling included, for chronic low back pain only: pain lasting 12 weeks or longer, with no identifiable systemic cause, and not tied to surgery or pregnancy. The benefit starts at up to 12 visits in 90 days, allows 8 more when the patient is improving, and stops at 20 a year. Treatment must be discontinued when the patient is not improving or is getting worse.

The detail that catches licensed acupuncturists is who gets paid. Medicare cannot pay an LAc directly. A physician may furnish the service, and a physician assistant, nurse practitioner, clinical nurse specialist or auxiliary staff member may furnish it if they hold a master’s or doctoral degree in acupuncture or Oriental Medicine from an accredited school and a full, unrestricted state licence, working under the supervision CMS requires. For an independent acupuncture clinic, that usually means Medicare patients with back pain either pay cash or are seen in a physician-led practice.

Elsewhere coverage is narrower than the insurance card suggests. Commercial benefits are set plan by plan, so two patients with the same insurer can have different visit caps. Personal injury and workers’ compensation pay more reliably but read your notes adversarially. VA community care runs on its own authorisation, more like a contract than a policy.

97810 to 97814: count contact, not retention

Acupuncture is billed in 15-minute units of personal, face-to-face contact. There are two families, without electrical stimulation (97810 initial, 97811 each additional) and with it (97813 initial, 97814 each additional), and only one initial code is reported per patient per day. Published payer policy is explicit on two points practices get wrong: time with needles retained while the patient rests alone does not count, and an add-on unit needs a fresh needle insertion, not just more minutes.

Here is the caution for any software, ours included. MegAligna computes units from the session’s recorded start and end time, divided by the unit length and rounded the way you configure for each payer. It cannot tell contact minutes from retention minutes. If a 45-minute visit held 20 minutes of contact, the units need correcting before the charge goes to your biller, and the note should say what the contact was. How the cash clinic’s superbill and the insured patient’s charge differ is covered on acupuncture billing software.