Acupuncture billing software: contact time, not room time

One record, two documents

A cash clinic wants a receipt, a superbill its patients can send to their own plan or HSA, and nothing else. A hybrid clinic has one or two insurance contracts, often growing faster than planned, and is learning that acupuncture bills on arithmetic it uses nowhere else. Both start from the same visit record; only the document at the end differs.

Fifteen minutes of contact, not forty-five minutes of room

The acupuncture code family (97810 to 97814) is built on 15-minute increments of personal one-on-one contact with the patient: the practitioner in the room, working. A patient resting alone with needles retained is not in contact. A 45-minute appointment with fifteen minutes of hands-on treatment is one initial increment, not three. The family also separates treatment with and without electrical stimulation, and initial from subsequent increments, so whether needles were re-inserted has to be in the note.

Here, units come from the visit’s recorded start and end times divided by the payer’s unit length, rounded the way you configure that payer. There is no separate contact-time field and the code split is not automatic, so for insurance visits the recorded times should reflect contact, and your biller confirms the codes and units against the note before they go out.

Medicare’s door is narrow, and it is not addressed to you

Medicare covers acupuncture only for chronic low back pain: pain lasting 12 weeks or more with no identifiable systemic cause, not tied to surgery or pregnancy. It pays up to 12 visits in 90 days, eight more if the patient is improving, and no more than 20 in a year.

It also does not pay licensed acupuncturists directly. The service has to be billed by a physician, physician assistant or nurse practitioner, with the acupuncturist working under that provider’s supervision and holding a master’s or doctoral degree from an accredited school and a full state licence. For an independent acupuncture clinic, Medicare patients are usually a cash conversation.

The 12- and 20-visit limits can be entered as an authorization, which counts visits against them at booking. Which provider is reported as rendering is a per-payer setting. Commercial coverage is wider and varies plan by plan; the parent page covers where acupuncture gets reimbursed.

Packages and memberships: not built yet

Much acupuncture revenue arrives as prepaid packages and memberships. Neither is in the product today: there is no package balance that draws down per visit and no recurring membership billing. Per-visit card payments, patient balances and statements are. A clinic that runs on packages keeps that ledger elsewhere for now.

For the cash patient’s own claim, the superbill generator produces one now, free, without an account. Superbills printed from inside the product wait on the AMA CPT licence.