Question: I recently noticed a relatively large increase in the allowed rates for my initial set of acupuncture (97810 and 97813) for my VA patients. Did I miss something, and why are other plans not making this higher payment?
You are indeed correct: For 2025 there is a substantial increase in value for the initial set of codes 97810 and 97813 for Medicare / the VA. Note: VA rates are directly tied to Medicare rates. This is true in states that use Medicare rates or “relative value units” to calculate their fee schedules, such as worker’s compensation and personal injury.
Based on your question, I can surmise that you are billing Medicare (Part B or C) and VA claims at your regular rate. You would otherwise not be aware of the rate increase unless you follow Medicare news very closely or attended one of my coding and billing seminars this year.
Yes, rates significantly increased in January 2025 due to increases in the relative value units (RVU) of 97810 and 97813. They roughly increased by 20% – the largest change to any code value for 2025, and a direct and indirect win for the profession!
What Happened
The RVU for 97810 went from 1.15 in 2024 to 1.38 in 2025, while the RVU for 97813 went from 1.36 in 2024 to 1.59 in 2025. This resulted in increased reimbursement rates. For example, in Los Angeles County, rates for 97810 and 97813 in 2024 were $41.31 and $49.28, respectively; in 2025, they are $49.65 and $57.12. Here are some other examples from around the country of Medicare rates for those two codes. Again, note that these rates are directly correlated to the VA and what the VA pays for acupuncture services.
But it is more than Medicare rates in some states where they use RVU to calculate reimbursement. Here are a few examples:
It is important to note that while billing Medicare, VA or other plans in which you may be enrolled as a member, you may bill at your regular rate – with the understanding that you may only collect per the allowed rates as noted on the plan’s explanation of benefits.
I assume this is how you became aware of the increase. If you were billing at the prior year’s allowed or contracted rates, you would not have realized the increase. This is why I recommend on plans of this nature to always bill your regular rate. That way, assuming your regular rate is above or at what is allowed, you will be paid the maximum allowed.
Billing Subsequent Sets
However, this is not the complete story when it comes to 2025 rates, as the RVU for subsequent sets (97811 and 97814) decreased. That said, even when billing for added sets, there is an aggregate increase in reimbursement for your services due to the large change to the initial sets.
Practical Takeaway
While not all plans follow Medicare and RVU when it comes to reimbursement rates, most do in some format. (Note that this is not applicable to plans managed by ASH.)
This should hopefully trigger an understanding to adjust your rates for 2025, particularly the initial sets; but also to be tuned into the RVU values and conversions published at the new year.
As I’ve said several times before in this column, this is why it is called acupuncture practice, not perfect. Changes and updates will always occur and continuing education is mandated, with some of the hours dedicated to ethical coding and billing.
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.
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