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Proper Billing for Acupuncture

When acupuncture is performed, an ABN should be given prior to the service being rendered. The CMS IOM Publication 100-03, Medicare National Coverage Determinations Manual, Chapter 1 Part 1, Section 30.3 Acupuncture states, “Medicare reimbursement for acupuncture, as an anesthetic or as an analgesic or for other therapeutic purposes, may not be made. Accordingly, acupuncture is not considered reasonable and necessary within the meaning of §1862(a)(1) of the Act.

The CMS IOM Publication 100-04, Medicare Claim Processing Manual, Chapter 30, "Financial Liability Protections Section 50.3.1, "Mandatory ABN Uses" states, “The following provisions necessitate delivery of the ABN:

  • §1862(a)(1) of the Act (not reasonable and necessary);
  • §1834(a)(17)(B) of the Act (violation of the prohibition on unsolicited telephone contacts);
  • §1834(j)(1) of the Act (medical equipment and supplies supplier number requirements not met);
  • §1834(a)(15) of the Act (medical equipment and/or supplies denied in advance);
  • §1862(a)(9) of the Act (custodial care);
  • §1879(g)(2) of the Act (hospice patient who is not terminally ill);

Therefore, when acupuncture is performed and billed to Medicare, the provider must obtain an ABN prior to the services being rendered. When billing the claim to Medicare, a GA modifier should be appended to show that a valid ABN was issued prior to the services being rendered. If a claim is billed for acupuncture with a GA modifier, the system will deny with a PR denial. If acupuncture is billed with a GY modifier, the claim will deny with a CO denial, and the provider cannot bill the beneficiary for the service.

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Proper Billing for Acupuncture
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