Needles and Billing: How do I charge for this stuff??
How do we bill for this?
That question gets asked in every class. Folks want to know how to recoup some of the money spent attending a dry needling course. Courses are expensive. Travel is expensive. Starting a new service line such as dry needling has some financial implications to it. So, you should want to know how you can get paid from it!
There are a lot of strong opinions on this. Just as you can imagine, with so many opinions, lots of therapists do lots of different things. Before you get excited and think that I'm about to give you a perfect recipe for how to bill for dry needling, let me assure you that I'm not. I can't legally or ethically tell you how to bill and that isn't my intention. I just want to clear up a few things to make sure you have all the data you need to make an informed decision. So here goes....
Let’s start with the American Physical Therapy Association (APTA). In 2014, the APTA released an official statement which can be found here or https://www.ndbpt.org/pdf/dryneedling.pdf. The bottom line from that official position by the APTA is they state: "the use of CPT code 97140 for the performance of dry needling should not be utilized." (97140 = manual therapy). The APTA also stated that "currently, there is no CPT code that describes dry needling." Because there was no CPT code to describe dry needling, the APTA recommended that therapists report dry needling using an "appropriate unlisted physical medicine/rehabilitation service or procedure code 97799."
What does that code mean??... It means no money.
There are tons of therapists that scoffed at this recommendation from the APTA, and since the APTA is not a regulatory body and is just a "national organization", their official statement was nothing more than a statement that was ignored. I dare say, a large majority of physical therapists bill dry needling as manual therapy (97140) and don't think twice about it. Personally, I believe dry needling is one of the most invasive and skilled forms of manual therapy that is possible, and that is the argument made by many clinicians billing dry needling as manual therapy. However, I also personally believe that I need to abide by the recommendations of my national organization (the APTA).
Now, enter 2020.
After many years of advocacy by the APTA and the American Chiropractic Association, the Centers for Medicare and Medicaid Services (CMS) assigned an active CPT code for dry needling which went into effect on January 1, 2020!
20560 = "needle insertion(s) without injection(s); 1 or 2 muscle(s)"
20561 = "needle insertion(s) without injection(s); 3 or more muscles”
Exciting stuff, right??!!??
Well, we can't blow up a balloon without sticking a needle in it...
According to Strata PT, a PT billing partner service company, even though CMS created two new codes for dry needling, "instead of finalizing these codes as "always therapy" or "sometimes therapy" CMS assigned a non-covered status to CPT codes 20560 and 20561. As CMS puts it, "dry needling services are non-covered unless otherwise specified through a national coverage determination (NCD)." Yep, they haven't done that yet..
So now we have a CPT code for dry needling, and it is not reimbursed by Medicare (or basically any other insurance company). What do you do now?
Well, for all of those therapists that have been billing dry needling as manual therapy and not thinking twice about it, now they are in a conundrum. THERE IS A CPT CODE FOR DRY NEEDLING. Because there is a CPT code for dry needling, if you do dry needling, then the appropriate code to bill is the dry needling CPT code. Billing dry needling as manual therapy now has no weight to it because dry needling has its own code. CMS doesn't care that it isn't reimbursed because that isn't their problem...its your problem.
Unfortunately, it is a problem that can only be solved through ADVOCACY. Until the dry needling CPT code is reimbursed, we kind of shot ourselves in the foot. You can't bill manual therapy anymore and the CPT code you should bill isn't reimbursed. All the cash-based practices are laughing all the way to the bank now!
If you've done some research, you may have come across some acupuncture CPT codes such as 97810, 97811, 97813, and 97814. Believe it or not, Medicare reimburses these codes for chronic low back pain. I had a previous student's billing/coding person email me and ask that since dry needling was similar to acupuncture, could they bill these codes to recoup some of their money.
THE ANSWER IS NO. NOPE. NAH. Don't even think about. Not even once.
Those acupuncture codes are for licensed acupuncturist performing acupuncture. Not a physical therapist performing dry needling. We can't have it both ways..."dry needling isn't acupuncture...unless I need to bill Medicare for it"... That's just wrong on so many levels, and it is also fraud.
You may wonder how in the world someone convinced Medicare to assign payment and accept acupuncture CPT codes. Well, the answer once again lies in ADVOCACY. There are plenty of physicians that perform Western Medical Acupuncture and they want to get paid for their services. Physician organizations are strong and plentiful with lots of money to hire lobbyists to influence this type decision. It was the APTA that advocated for the dry needling CPT codes, and they will continue to advocate for reimbursement of these new codes. BUT YOU HAVE TO SUPPORT THEM!
It's not easy. Being an APTA member isn't terribly expensive, but it isn't super cheap either. My $500 payment is due by July 31st. I can think of a long list of things I'd rather spend $500 on that does not include the APTA. But it is the RIGHT THING TO DO.
So, bottom line, I still didn't tell you how to bill for dry needling. If you've been to a live dry needling course with United Dry Needling Education, then you know we have an honest discussion about billing and we talk through some of the issues and what I've known other therapists to do and even what I do personally where I work. But, a blog isn't the place to give those details. I simply wanted to clear up some of the confusion about dry needling and acupuncture CPT codes.
Hope this helps!
Here's a decent article to review by a PT billing service partner company called Strata PT.