Samuel A. Collins
The VA Community Care system has been a great resource for patients in need of acupuncture care for a variety of conditions, primarily pain management. The system has allowed many veterans access to the benefits of acupuncture.
The allowance of care for an acupuncture provider can be generous, with care plans that allow for not only three units of acupuncture, but also evaluation & management services, and physical medicine services.
Services / Billing Codes Allowed Under the SEOC
The standard episode of care (SEOC) for acupuncture includes the following services: Acupuncture initial care includes 20560, 20561, 97016, 97026, 97110, 97112, 97124, 97140, 97530, 97810, 97811, 97813, 97814, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 0552T, and S8930; acupuncture continuation of care and chronic care management includes 20560, 20561, 97016, 97026, 97110, 97112, 97124, 97140, 97530, 97810, 97811, 97813, 97814, 99211, 99212, 99213, 99214, 99215, 0552T, and S8930.
What About 97039 & 97139?
Note, however, that the above code set does not include either 97039 or 97139, unlisted physical medicine codes that were present in the SEOC prior to a February 2024 update.
Both codes were used to indicate “cupping,” and allowed and reimbursed from the outset of the VA Community Care program. Providers would use the unlisted codes, indicate as cupping, and be reimbursed.
The Recoupment Issue
However, in 2024, multiple providers, particularly those with Optum Health, received recoupment letters for repayment of services previously coded under the two unlisted codes. There was panic in the profession, as some of these recoupments were for multiple years and some offices were requested to repay hundreds of thousands of dollars.
This is where the American Acupuncture Council and American Acupuncture Council Network were brought in, as many insured or members of the network were in full panic mode. Upon research, the unlisted codes were part of the SEOC and properly documented, and should not have been subject to recoupment. In fact, from 2021 to 2024, the codes were indicated and of course payable.
Providers were then instructed to respond to the VA, noting its own rules indicating it was appropriate. As a consequence and to the VA’s credit, it reviewed the data and suspended the recoupment.
First, a directive sent by the Network Provider Advocate, Network Management of OptumServe, stated:
“Optum’s Claims Department worked a special project intended to remediate a historical claims logic concern which impacted unlisted procedure codes. Although our analysis of the unlisted procedure codes is ongoing, the current recoupments are in the process of being voided. We sincerely apologize for the inconvenience this has caused and appreciate your patience as we work to void these specific recoupments regarding the unlisted procedure codes. Additional communication will be sent in advance of any further actions related to the unlisted procedure codes after our internal analysis is complete.”
Subsequently, in a letter dated July 26, 2024, Optum indicated it was cancelling the refund request. It did indicate it was doing further research, but the SEOC published at the time the services were performed did indeed allow the use of the unlisted service codes.
Moving Forward
The code for cupping was changed as of February 2024; the code to be used is now 97016: Vasopneumatic Device. Reimbursement is lower than what was allowed for 97039, but remains payable.
Editor’s Note: Have a billing question? Submit it to Sam via email at sam@hjrossnetwork.com. Submission is acknowledgment that your question may be the subject of a future column.
