Editor's Note: The following is authored by Sam Collins, "Ask the Billing Expert" columnist.
I have received notice that Optum Health is rescinding recoupment for past payments of cupping under the unlisted service code 97039. Many member offices had received letters of recoupment that amounted to thousands of dollars.
Prior to this update, I received multiple inquiries from acupuncture providers in a panic. Optum indicated that the use of 97039 was improper to identify cupping. This began in approximately February, as the VA Standard Episode of Care (SEOC) deleted the unlisted service codes 97039 and 97139 for acupuncture.
However, the SEOC, from 2021 through January 2024, did indeed publish and include 97039. While the 2024 update removed the code, it was present for the period they were seeking recoupment and therefore that recoupment was improper.
Optum has now indicated it is suspending recoupments, as evidenced by the following statement from its Network Management and Provider Advocate team:
“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 theses 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.”
That means any prior recoupment based on when the SEOC was published will cease. However, bear in mind that cupping should no longer be coded under 97039, but only 97016.
I will follow up with a more complete accounting of this development in an upcoming “Ask the Billing Expert” column in Acupuncture Today.
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