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Regular updates for provider resources will be available on this page.
October 31, 2016
Effective Nov. 1, 2016: CareOregon will pay a maximum of two units of additional acupuncture per visit (CPT codes 97811 and 97814), in addition to the code for the initial encounter (97810 and 97813). Additionally, CPT codes 97811 and 97814 by definition can only be used for a reinsertion of acupuncture needles.
Secondly, the proper billing and coding of acupuncture services does not allow the routine use of Evaluation & Management codes. E&M codes are permitted with an initial encounter, but should be an infrequent occurrence thereafter.
As we near the end of our first full calendar year of providing an expanded acupuncture benefit, we plan to perform random auditing in the future to verify appropriate services are being delivered, and that clinical documentation supports billing. Please ensure all coding and billing complies with the above guidelines.
Additional Resources for Providers
Best Practices and Health Promotions
Medicaid Management Information System (MMIS) through the DHS
Quality Improvement Program Summary 2010
Partners and Programs
Care Support and System Innovation (CSSI)
Primary Care Renewal