Wiki Acupuncture denials from Medicare for "frequency"

[ctobin01]

We are providing acupuncture in a hospital-based outpatient department. Both the physicians and the hospital are getting denials due to "frequency" when the patient has not exceeded the max limit of 20 visits in an 11 month period. Is anyone else experiencing this? Neither the pro fees or hospital charges are being billed out with any modifiers to indicate tech vs pro charges. Is anyone else using -TC or -26 on acupuncture claims? Just wondering if we need to. Thank you.

 

[iowagirl77]

I don't have experience with billing acupuncture; however per https://www.medicare.gov/coverage/acupuncture :

Medicare Part B (Medical Insurance)
covers up to 12 acupuncture visits in 90 days for chronic low back pain.

Medicare covers an additional 8 sessions if you show improvement. If you aren't showing improvement, Medicare won't cover your additional treatments and they should be discontinued. You can get a maximum of 20 acupuncture treatments in a 12-month period.

Perhaps you can appeal with records showing improvement if this is the case.