Does Insurance Cover Dry Needling?

Some insurance companies may not cover dry needling.

Why does insurance not cover dry needling?

Dry needling of trigger points for the treatment of myofascial pain is not covered since the evidence to assess the technology’s effects on health outcomes is lacking. The use of dry needling of trigger points to alleviate myofascial pain is not regarded medically required.

How much does dry needling usually cost?

People should contact their insurance company before scheduling a dry needling appointment to verify if the therapy is covered and, if so, what the company requires to submit the claim. A list of approved or in-network practitioners may also be available from the insurance company. Dry needling treatments are priced differently depending on the practitioner. Some charge between $40 and $60 per session, while others charge as little as $15.

People who receive dry needling typically attend three to six sessions. Depending on the severity of the pain and how well the therapy is working, further sessions may be required.

In the absence of insurance coverage, the practitioner may provide a value pack of many sessions, which can be beneficial. Clients without medical insurance or dry needling coverage may be charged a reduced rate.

How is dry needling billed?

For a long time, the proper labeling of dry needling, sometimes known as trigger point needling, has been a source of consternation. For several years, the American Chiropractic Association (ACA) and the American Physical Therapy Association (APTA) have collaborated to develop codes to characterize this service. They gave a presentation to the American Medical Association (AMA) CPT Panel in September 2018, and the panel authorized new non-time-based codes for the Surgery portion of the CPT code book in the following year “Section “Procedures on the Musculoskeletal System” These new codes will most likely go into effect on January 1, 2020, and will describe needle insertion(s) without injection(s).

So we’ll have to bumble our way through another year. Essentially, it comes down to what the payers want. The issue is that, despite the fact that different professional associations have announced their policies, payer policies vary. Let’s have a look at the differences.

The American Medical Association (AMA) recommends using code 20999, which can be found in the CPT Assistant, October 2014 (emphasis added):

Dry needling (DN) is a treatment that involves penetrating the skin with a small filiform needle to activate underlying myofascial trigger points, muscles, and connective tissues. An article published in the September 2003 issue of CPT Assistant clarified proper reporting of trigger point services performed using a “dry needle” technique, stating that codes from the (20550-20553) code range are not intended for reporting a “dry needle” technique, and that dry needling techniques may be reported with the unlisted procedure code 20999, Unlisted procedure, musculoskeletal system, general.

APTA: According to an APTA statement from 2014, “If no such code exists, use the relevant unlisted physical medicine/rehabilitation service or procedure code 97799 to report the service.”

Lousinana’s BC/BS: To add to the confusion, a new Blue Cross/Blue Shield Professional Provider Office Manual Addendum (June 2018) gives new instructions on coding dry needling (emphasis added):

When therapeutic procedures (i.e. 97124 & 97140) used to relax or prepare the patient for manipulation are performed in the same location on the same day, they are deemed vital to the manipulation and are covered by the manipulation reimbursement. Even if conducted in the same region on the same day, dry needling may be reimbursed separately and should be invoiced as code 97140 with Modifier 59.

Because there is currently no CPT code for dry needling, this service should be invoiced using CPT code 97140. This service should not be billed with unlisted CPT codes. Modifier 59 should be added to 97140 if dry needling is performed on the same day as chiropractic manipulative treatment (CMT) so that it can be paid separately.

If the payer does not have a preferred code policy, it may be claimed that either 20999 or 97799 could be invoiced appropriately. Because the new codes will be in the surgical section, code 20999 may be a better option to utilize until the new codes are ready in 2020.

There are disparities in scope of practice between states and organizations, just as there are differences in coding policies. National policies may be able to help explain the situation as new codes are assigned. Acupuncturists have previously challenged the use of dry needling by physical therapists, claiming that it amounted to acupuncture without a license. The new regulations, on the other hand, make it clear that dry needling is not the same as traditional acupuncture. Some states consider dry needling to be within the scope of practice for physical therapists, while others do not. To find out the rules in your state, contact your state professional association.

Is dry needling covered by Medicare 2021?

Dry needling is not covered by Medicare, even if it is used to treat chronic lower back pain. Acupuncture is covered by Medicare, but how much does it cost? Lower back discomfort is covered by Medicare for up to 12 acupuncture sessions every 90 days.

Can chiropractors perform dry needling?

For millennia, the use of needles for therapeutic purposes has been identified solely with the field of acupuncture. However, this appears to be fading.

As other professions have adopted acupuncture and given it a new name, a discussion has erupted about what exactly constitutes acupuncture and who should be permitted to inject small, sterile needles into patients’ skin.

This year, the dispute spilled over into the Indiana General Assembly, which passed a bill allowing chiropractors to do dry needling but prohibiting them from performing acupuncture unless they are properly trained.

Dry needling is a technique in which a practitioner inserts needles directly into a patient’s muscle with the goal of activating a twitch reaction in the muscle that is supposed to lead to healing. It is used by both physical therapists and chiropractors across the country.

Is dry needling considered experimental?

The United States Food and Drug Administration does not regulate dry needling because it is considered a technique. Dry needling of myofascial trigger points is a research/experimental technique. It hasn’t been proven in a scientific study to improve patient clinical results.

Why is dry needling illegal?

Because the physical-therapy sector is significantly larger and more prominent than the acupuncture community, dry needling is rapidly expanding. According to the New York State Office of the Professions, there were 22,077 licensed physical therapists and 4,146 licensed acupuncturists in New York State in 2015. Physical therapists also have increased clout in Washington, DC; according to its website, the American Physical Therapy Association has a $43.5 million budget and represents more than 95,000 members. The American Association of Acupuncture and Oriental Medicine, on the other hand, does not even have a phone number on its website.

Mona Lee Yuan, an acupuncturist and physical therapist from New York, has been working with state and national organizations to prohibit physical therapists from doing dry needling. She is aware, though, that it may be difficult.

How long do the benefits of dry needling last?

It’s usual to feel a little painful after dry needling, and you’ll see an improvement in your symptoms within one to two days. The benefits will last a different amount of time depending on the person. The first few treatments usually provide a short period of relief that lasts a few days. Your practitioner’s goal with each consecutive session is to extend the time you feel better after therapy. Every session will usually result in less soreness and faster and longer-lasting effects.

Is needling the same as acupuncture?

One of our patients recently inquired about the differences between dry needling and acupuncture.

Physical therapists and chiropractors commonly use the word “dry needling” to denote a needle-based treatment for muscle stimulation. The procedure is known as dry needling since the needle does not inject anything into the body.

Dry needling and acupuncture both utilize the same tool. Acupuncture needles, which are solid filiform needles, are used in both disciplines.

The technique and philosophy for how and where the needles are put differs between dry needling and acupuncture.

Dry needling focuses on employing high-intensity stimulation to stimulate muscles to release. Acupuncture, on the other hand, does not require forceful stimulation and is based on the principle of channels and the use of points to naturally cure the body.

As a result, the patient’s experience will be vastly different between these two types of treatment. Dry needling can be uncomfortable, whereas acupuncture is not.

Another significant distinction between dry needling and acupuncture is the level of training necessary to perform each of these treatments. Acupuncture necessitates a lot more education. Although it varies by state, it usually necessitates graduation from an accredited school as well as hundreds of hours of classroom and clinical practice experience.

Dry needling, on the other hand, takes very little preparation. Physical therapists in Tennessee, for example, simply need to complete 24 hours of classroom instruction to provide dry needling treatment.