Can acupuncture be paid for conditions beyond pain?
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Hi everyone. This is Sam Collins, your coding and billing expert for acupuncture, the American Acupuncture Council. And of course, just the profession. Welcome to another episode to always help you get your practice uplifted, make sure you’re getting paid for what you do, because that’s what I do. We try to make sure that you get your claims paid, can get paid for your services.
One of the questions that I get quite a bit, is, can I get reimbursed for codes beyond pain? Now, of course, I’ve been teaching acupuncture seminars now for some 26 years, and so we often get people saying what’s now what was then truthfully, if you went back to a seminar I did in the nineties or early two thousands, there were very little reimbursement beyond simply pain that has changed quite a bit.
We still have to understand, that it’s not quite as open as we would like, but much more so it’s good to know what will get paid and can I get paid beyond pain? So let’s go to the slides. Let’s take a look at what’s occurring here. What’s going on with insurance and reimbursements for acupuncture now as always, here’s my email.
Here’s our website as well, but let’s focus in on acupuncture covering. When insurance has to pay, what do they pay for? And I think this is often where people get off track. The assumption is, oh, they pay for everything. Not quite. And there can be nuances that some will pay for more than others. In fact, there’s one that honestly will pay for everything, which I’ll give you a demonstration of.
One of the things we have to think of is how do people foresee or what do they see when they think of acupuncture? Think of it. Ask your friends, ask an acquaintance. What do you think? I. What do we treat in acupuncture? And I think you’ll invariably give you it’s pain and have an ignorance toward, and it’s part of our.
I think to make sure they understand we do more than that. So by example, I’m showing two offices this year that have some signs up near their office or in their office that talks about the things they treat. Notice this one on the left talks about fatigue, stress, anxiety, depression. And in fact, they don’t get down to anything towards pain until the very end, because how many times people have these types of conditions and think, oh, they don’t associate it that way.
Is there coverage for it? I think partly is making sure people know that acupuncture can treat. And more importantly, or maybe not more importantly, but just as a. Can I get my insurance to pay for it. Look at this other one, they talk about pain first, but then brings in things like anxiety, depression, Bell’s palsy.
Heck I think a Justin Bieber, if you’re familiar with his condition probably should be getting some help from an acupuncturist. So it’s really understanding what do plans cover. Can it be more than just pain? Cause that’s what. Obviously, many of you are aware of the American specialty health model, which I will call the musculoskeletal model or an often I’ll think of it as the physical therapy chiropractic model in that what they cover things like headaches, hip, or knee pain associated with arthritis or extremity pain with arthritis or other mechanical irritation, meaning strains and sprains, or just pain syndromes of the joints and soft tissues back and neck pain.
So you can see here for the most. It’s mostly just pain. A little bit to Nazi with pregnancy, but notice nothing here about abdominal pain or how about anxiety, depression, or anything else beyond that generally? No. Now the good news is pain is often what you’re going to have with any condition, how it manifests itself, but this can be fairly limiting and for many plans can be.
So by example, is there something I can do more than. And not all carriers are the same. There are going to be differences between each of these. And I’m going to demonstrate some of the differences that you’ll see among these to start to give you an idea of it. I’m going to recommend this is why you want to get more continued education with programs like ours, to really get the full breadth of what can be covered and the nuances from state to state region.
So by example, here’s the newest Aetna protocol. And as you’re probably aware all Aetna policies that are now from their commercial line have to cover acupuncture, but you’ll notice here it’s still pretty limited. It’s limited because it says it covers neck pain and headaches, low back pain, nausea, arthritis, chemotherapy-induced nausea and TMJ disorders.
That’s good. This is a pretty nice. Only pain, but it is when you look at these other than the arthritis, so this one could be pretty limited. The good news is Aetna will tell you what codes they cover. So here’s their list, everything from migraines, all the way down to postoperative pain to the teeth.
So pretty limited. Now the thing that this list says though, is that it’s not all inclusive. So the difficulty is you get a list like this and you think, okay, great. This is what I know they’re going to cover. You build these, they pay it, but are there other things that I can do. That they may pay. What we have found is generally other joint pain, but I’ve had a few offices believe it or not with.
That have been covered for anxiety, depression, with the code M 48.1, certainly something you could venture into and just say, if I’m treating that, is it a possibility? Many of them are working concurrently with some type of medical provider treating it as well, but you can dip your toe. What I can say is this one though is pretty straightforward.
This is what they’re doing. Without question, as you can see. That’s pretty much pain Sam. What about Cigna now? Cigna, this is their newest coverage and they cover a lot of things. You’ll notice here in the bullets that says tension types, headaches, migraines, musculoskeletal joint, nausea, post-surgical pain and chemotherapy induced nausea.
So you’ll notice it again is still along the pain. Now this list from Cigna though is vast. If you tell me any joint with a stranger. Or any type of pain to a joint, they’re going to cover it. Myalgia, fibromyalgia. You bet pretty ubiquitous, but again, is it beyond pain? Not really. Not until you get into companies like this particular one.
This is the company Evercore. And to give you the background, Evercore is behind the scenes for most of the products that are sold under Anthem, meaning blue cross blue shield. United health care. And of course, Optum and you’ll notice right off the bat, what they cover are pretty much pain codes. You’ll see.
Okay. The neck, the back musculoskeletal, cervical cranial lumbal sacral pain. But then you’ll notice that the very end of the list, it says internal medical conditions, and this is something that’s remarkable and has been around now for about three years. Take a look at what things. Adjunct cancer care.
Now I want to be careful. They’re not saying they cover to treat cancer, but they’re paying you to treat the symptoms associated, the nausea, the vomiting, the other conditions associated with it. Notice also the mental health conditions. These are things like PTSD. Believe it or not anorexia bulemia but also depression, anxiety.
I would suggest, always be working with probably concurrently, but at the same token, this is something they’re not saying no to notice allergic rhinitis, adjunct post-stroke dry eye syndrome, constipation prostititus pain, asthma irritable bowel. Of course the vomiting you’ll stupid. Look at the very last one medical.
And this particular one, they’re not covering menopause just to say what are we treating you? Don’t you’re actually treating insomnia. And hot flashes. So there’s really been a great growth here. Now I’m going to recommend, again, probably to dig in a little bit more. This is what we do, and that are more advanced or navigating the insurance seminars.
But you can see here while this is a little beyond, I particularly really hope some of the offices that when I first taught seminars, always taught to say, Hey, let’s talk about the code you get paid for. And they said, we didn’t do an internal medicine. I said we didn’t because it’s not paid. Now you can see here.
This is beginning to get paid. Now this company again, I did Anthem’s Optum’s are going to be more or less. In addition. What about another company like health partners? I know a lot of you in the Midwest area will see this one and they do have a pretty good amount of coverage for all the musculoskeletal things as you’ll see here.
But it goes beyond that. Look at section V here, PMs or menstrual disorders. In fact, they give a list of codes and you’ll notice here things like interstitial cystitis, Macedonia, menstrual disorders, vomiting, but take a look at the last. Weakness fatigue, malaise. There’s a lot of change that’s occurring that there’s going to be more so it begins, start asking, will this plan cover and don’t be afraid to ask, does it cover fatigue?
Does it cover abdominal pain? Will it cover prostititus pain, things of that nature to know, because not often as much as I’m showing you this list, does every insurance company produce a little. Not always. So we want dig a little bit further to say what’s covered and I would suggest start keeping a list.
That’s one of the things we emphasize in our program to know the codes that are covered or not covered that way. You have the best idea of making sure you get the best benefit. One thing we want to be clear with the patient, what’s going to be covered. Don’t be fooled. Don’t let your patient before. If you’re not sure something is covered, don’t be afraid to say we will bill your insurance.
And we hope they cover, but we’re never going to guarantee that’s the downside. People want to make people or patients believe everything’s going to be covered. You’re going to give, we’re going to bill your insurance confidently with the condition you have. Will your insurance absolutely cover. We can’t guarantee it until once we build now, here’s the beauty of this start collecting this data.
Does this insurance pay this particular diagnosis? Keep in mind. Most of you don’t use a lot of diagnosis and that’s okay because you see a lot of the same things, but begin to learn which ones are or are not covered. Notice this one here. If someone just comes in and says, I feel tired, health partners is going to cover it, but take a look.
This is one of my latest VA. For the VA take a look at this. This is just this may and notice what it is. Provisional diagnosis, tobacco use to help console the patient there. Now the VA is authorizing for some people to go, let’s try acupuncture to help with this addiction. Notice it says to assist with smoking cessation.
So have we changed? Is there more access to what you do? Yeah, because it’s beginning to be recognized. It’s one of the reasons we’re moving towards ICD 11 is to make sure that we can better account for all the things that acupuncture can do. My hope is we move to something like this. One, take a look for any of you that are in Massachusetts.
You have the Mecca of coverage, blue cross blue shield of Massachusetts. Now covers is in way that most aren’t even aware of. I want to see every state do this. Acupuncture benefits for 12 visits per year, for any reason. So this particular plan is saying, I don’t care what you have. We’re going to cover you for 12 visits.
In other words, an acupuncturist can be an acupuncturist, treat what you’re seeing, not to try to fit into some other guidelines. Notice here, all the things they’re talking about, dental pain, addictions, headaches, menstrual tennis, elbow, fibromyalgia. Now some of that is painted up, but notice digestive, emotional ear, nose, and throat.
Gynecological issues, literally anything. My hope is that we continue to move forward this way, because part of the best way for acupuncturists to get coverage is to collect data among what we treat. So imagine someone with let’s look neurological that has Parkinson’s disease, and we start to collect data that wow, people who have Parkinson’s that get acupuncture have resulted better from.
Do you think that might be something that will be more useful for the patient, but also for the insurance, remember acupuncture is always going to be the more economical choice. And so the movement forward is acupuncture. Can’t be hidden. It works and it works with. So as a consequence, better coverage. So I want to start to say to you, get out and look nowhere you can go.
That’s why we offer this service called the network, get an expert, which means me on your staff. Just hold your phone up to that. QR code will bring you right to the site so you can dig into this. Our Accu code has this list as well. We want to make sure you have the best information. Or no one it’s not going to be paid.
The American acupuncture council is your ally and your resource. Our group is the network. You can go to our site, take a look. Obviously many of you are insured with us as well, but at the same token, we want to be a resource that you can be helped to make sure that your practice continues to thrive and grow.
And that’s going to be about access to your. So I’m going to say to all of you, thanks for that time. Next week house will be Jeffrey Grossman, as always, I’ll say to you, it’s good to be important, more important to be good, be that person to your patient, make sure they can get access to care. The number one problem with acupuncture is people not understanding what you do and gaining access and gain their trust.
Let them try it. They’re going to get better. See you next time.