Do the fees charged by licensed acupuncturists reflect the services provided? It was early during the COVID-19 pandemic; I was spending an hour a day meditating, learning about Sars-COV-2 and taking phone calls from patients asking for advice – advice such as, "The pain management office wants me to go in for an injection, but I don't have any pain. They are not listening to me and pressuring me to go. What should I do?" This was during the first week that a pandemic was declared by the World Health Organization.
Some time passed, and I found myself in a peaceful routine away from the clinic, but I became aware of matters that were a source of unknown stress previously. Was it the hour-long meditations that had pulled the curtain aside to reveal that which I had been unaware of? Probably.
I am a second-generation acupuncturist and herbalist who practices integrative medicine, similar to my mother. I provide a lot of pro bono care to patients who live under the poverty level. I find immense satisfaction from volunteering at free clinics. But in my pay-for-service practice, I do not have the same level of satisfaction. I wondered why that was.
Are We Charging Enough?
I provide additional services to my outpatient patients; that's one difference. I provide services I have spent thousands of dollars to pay for and thousands of hours studying to master. However, I do not charge patients for the additional services I provide. I do not provide these services at the free clinic. Why do I not charge for doing additional work?
I do not know the genesis of the typical two-tier fees acupuncturists have in the United States. The two-tier fees include an initial fee and a follow-up fee. When a patient comes in with a new condition that requires 15 to 45 minutes of an acupuncturist's time to evaluate, the patient expects to pay the follow-up fee. The more I thought about it, the more it was clear this is not a fair exchange.
Proposed Changes to the Fee System in Acupuncture
I propose, for your consideration, the following changes to the two-tier fees:
Evaluation fee, based on condition and time required to review medical charts and consultation
Acupuncture fee, charged per 15 minutes of needle insertion, in line with insurance billing
Phone calls should also incur a fee, in line with telemedicine fees
Nutrition, lifestyle and meditation counseling should have additional fees as well
The one initial fee and one follow-up fee do not make sense, nor are they reflective of the work we do. The amount of work that is required of me to treat / evaluate / manage an ankle sprain, for example, is different from treating paralysis due to a spinal cord injury. Charging the patient the same fee to treat an ankle sprain and paralysis is unethical and unfair. In my opinion, we need to remove the two-tier fees for acupuncturists. The fees we charge must be reflective of the services we provide.
Editor's Note: This article is relevant to discussions on the cash-based fees acupuncturists charge their patients. For a discussion of fees relative to billing and insurance reimbursement, read Sam Collins' article on new fee rates for 2022 in this issue.
On April 1, 2026, China implemented a landmark national standard: Classification and Determination of TCM Constitution. Although designated as a recommended rather than mandatory standard, it represents a major step in modernizing traditional Chinese medicine (TCM) by converting traditional constitution theory into a clear, measurable and clinically practical framework. By clarifying the relationship between constitution, disease, and pattern differentiation, the standard strengthens professional credibility, supports research, and enhances patient-centered treatment.
The field of acupuncture in the U.S. continues to grow in visibility, patient demand and clinical effectiveness. Yet behind the curtain, many acupuncturists are quietly struggling to keep their doors open. While the profession is rooted in centuries of healing tradition, modern economic pressures – particularly those driven by insurance limitations, low reimbursement rates and job-market saturation – are making it increasingly difficult for licensed acupuncturists to thrive.
A student stands over a patient, needle poised. They have a “perfect” prescription: a textbook combination of points harvested from a lecture slide on chronic lower back pain. But as the needle meets the skin, the student hesitates - the symptom of a quiet habit that has taken hold of our profession. We routinely say we “prescribe” points. It sounds efficient. It echoes the authority of biomedical culture and fits neatly into the insurance field. But vocabulary is never neutral; repeated long enough, it dictates behavior.
