Expanded CPT Codes for Acupuncture May Be Coming

Current Procedural Terminology (CPT) codes are widely used to identify procedures for the purposes of insurance billing. Originally developed by the Health Care Financing Administration to assist in the assignment of reimbursement amounts to providers by Medicare carriers, they are now moderated by the American Medical Association (AMA), and are used by managed care organizations and other insurance companies to determine reimbursement for certain services. Each year, the AMA revises the CPT codes as deemed necessary, and publishes them in a mammoth text aptly named the Current Procedural Terminology Codebook.

The idea behind CPT codes is to have a uniform system to classify medical, surgical and diagnostic procedures. Language included in the recently-enacted Health Insurance Portability and Accountability Act (HIPAA) has increased the importance of the CPT codes by having them designated as the national code set for claims from all health care providers, including acupuncturists, herbalists and other complementary and alternative medicine (CAM) practitioners.

In addition to the HIPAA revisions, there are signals that new alternative therapy CPT codes may be on the horizon. This was evidenced by the fact that the American Association of Oriental Medicine (AAOM) and the American Academy of Medical Acupuncture (AAMA) were among a select group of health care organizations invited last year to the American Medical Association (AMA) CPT Editorial Panel's meeting of its Alternative Therapy Services Work Group. Other attendees invited to participate in the October 3, 2002 meeting in Chicago, Illinois included the American Massage Therapy Association; the American Physical Therapy Association; the American Occupational Therapy Association; and the American Nurses Association.

The CPT Editorial Panel functions to update and maintain the CPT code set. According to the AMA, the panel's work group is charged with "evaluating alternative therapy payers' and providers' reporting needs, developing review criteria for alternative therapy descriptors, and selecting alternative therapy fields in which it may be advisable to begin developing proposals for new CPT codes."

Acupuncture is a relatively recent addition to the CPT code set; on January 1, 1998, the AMA added codes 97780 for acupuncture without electrical stimulation and 97781 for acupuncture with electrical stimulation. The CPT code set also contains codes for related therapies such as massage, hot and cold packs, and manipulation. In California, acupuncturists who treat injured workers under workers' compensation may use different codes for acupuncture (with or without stimulation), cupping and moxibustion.

Adding new CPT codes for specific types of acupuncture, or modifying existing codes to include different therapies, could have a profound impact on the way acupuncturists run their practices. Although the majority of acupuncturists do not bill insurance companies for reimbursement and prefer to work on a cash basis, some acupuncturists already utilize some level of insurance reimbursement in practice, and this trend is expected to increase in the coming years.

According to AMA sources, several new alternative therapy codes may be approved within the next 12 months. However, these sources also note that any proposed codes will need to reflect organizational consensus within the profession.

Acupuncture Today will report on any changes to the CPT code set as the information becomes available.