As a healthcare provider, it is important to know what services are covered by insurance providers. One such service that has gained popularity in recent years is dry needling. However, there is often confusion about whether Medicare covers this type of therapy.
Dry needling, also known as myofascial trigger point dry needling (MTrP-DN), uses small needles to stimulate specific points within muscle tissue for therapeutic purposes. It is an effective treatment option for many different conditions including chronic pain syndromes, musculoskeletal disorders and sports injuries.
While dry needling has been used for decades across the world, it only began to gain widespread attention in the United States in the last 20 years. Despite its increasing popularity among both patients and healthcare providers alike, there are still questions about whether Medicare provides coverage for this type of therapy.
Firstly, let’s take a closer look at how Medicare works and what it covers. Medicare is a federal health insurance program designed primarily for those who are over 65 or have certain disabilities or medical conditions. The program consists of two main parts: Part A which provides hospitalization coverage and Part B which provides outpatient medical services such as doctor visits and laboratory tests.
Dry needling falls under Part B coverage since it is considered an outpatient procedure performed by a licensed healthcare provider. According to Centers for Medicare & Medicaid Services (CMS), “Medicare covers acupuncture solely for chronic low back pain if deemed medically necessary by your physician.”
However, despite similarities between acupuncture and dry needling techniques some resourceful doctors use CPT code 20552 Dry Needing when administering Dry Needing Therapy because most insurances cover CPT code 20552 without limitation related with diagnosis coding restrictions like diagnostic codes required specifically while billing needle insertion technique through CMS sanctioned Acupuncture Modality reimbursement system limits payment linked with Acupuncture therapeutic results restricting superfluous billings however even those codes seem problematic when applied recently.
This means that whether or not Medicare covers dry needling therapy depends on the specific diagnosis made by your physician. If it is determined that dry needling is medically necessary for a patient’s particular condition, then it could potentially be covered under Part B of Medicare.
However, despite this good news, here comes an unanswered question: Despite CMS coverage through 97% acupuncture codes how many among these insurance policies are covering Dry Needing Therapy?
Furthermore, per National Correct Coding Initiative (NCCI) and American Medical Association (AMA), there has been significant controversy surrounding CPT code 20552 and its use to bill for myofascial trigger point dry needling specifically. The NCCI has issued edits indicating that this code cannot be used in conjunction with other manual therapies such as massage or spinal manipulations – which are often used alongside dry needling to achieve optimal results – leading to increased confusion amongst providers and denied insurance claims due to incorrect coding.
In summary, while there is some coverage potential for patients seeking dry needling treatments under Medicare Part B based on the 97% Acupuncture Modality Codes sanctioned by Centers of Medicaid & Medicare Services (CMS) established recently; as well as also taking into account what diagnostic code was billed along with CPT code 20552 – chronic low back pain being crucial yet mandatory criterion- ongoing education about proper coding methodology when billing for MTrP-DN services remains vital.
References:
https://www.medicare.gov/coverage/acupuncture
https://www.apta.org/news/2019/10/21/ncci-edit-ribbon-opportunity-to-clear-up-coding-confusion-over-dry-needling
As a healthcare provider, it is crucial to be aware of what services are covered by insurance providers, especially as new therapies gain popularity. One such therapy that has grown in demand over recent years is dry needling, also known as myofascial trigger point dry needling (MTrP-DN). This technique involves the insertion of small needles into specific points within muscle tissue for therapeutic purposes and can offer relief for a range of conditions such as chronic pain syndromes, musculoskeletal disorders, and sports injuries.
Although dry needling has been utilized globally for decades and gained traction in the United States over the last 20 years or so, there remains confusion about whether Medicare provides coverage for this type of therapy. First off, let’s take a closer look at how Medicare operates and what services it covers. Medicare is a federal health insurance program designed primarily for individuals aged 65 or above or who suffer from certain disabilities or medical conditions. The program consists of two critical components: Part A offers hospitalization assistance while Part B encompasses outpatient medical services like doctor visits and laboratory tests.
Dry needling falls under Part B coverage since it falls under an outpatient procedure performed by a licensed healthcare provider. According to Centers for Medicare & Medicaid Services (CMS), “Medicare covers acupuncture solely for chronic low back pain if deemed medically necessary by your physician.” However, despite similarities between acupuncture and dry needling techniques some resourceful doctors use CPT code 20552 Dry Needing when administering Dry Needing Therapy because most insurances cover CPT code 20552 without limitation related with diagnosis coding restrictions like diagnostic codes required specifically while billing needle insertion technique through CMS sanctioned Acupuncture Modality reimbursement system limits payment linked with Acupuncture therapeutic results restricting superfluous billings however even those codes seem problematic when applied recently.
Thus whether Medicare covers dry needing depends on the specific diagnosis made by your physician regarding its medical necessity concerning your condition; then, it can be potentially covered under Part B of Medicare. However, despite this positive revelation, the question that begs answering is how many insurers will cover Dry Needling Therapy regardless of CMS coverage sanctioned by Acupuncture Modality codes making up a 97% guarantee?
Moreover, complications arise with CPT code 20552 and its use for billing myofascial trigger point dry needling specifically. National Correct Coding Initiative (NCCI) and American Medical Association (AMA) have disputed the efficacy of this code alongside other manual therapies such as massage or spinal manipulations which may accompany dry needing to realize optimal results. The resultant confusion often leads to providers receiving denied insurance claims due to incorrect coding methods.
In conclusion, while some potential coverage exists for patients seeking dry needing therapy on Medicare Part B based on the 97% sanctioned Acupuncture Modality Codes by Centers of Medicaid & Medicare Services (CMS); in addition to determining what diagnostic code was billed together with CPT code 20552 – chronic low back pain significantly mandatory criteria- providers must remain well-educated about proper and acceptable coding methodologies when billing for MTrP-DN services.
References:
https://www.medicare.gov/coverage/acupuncture
https://www.apta.org/news/2019/10/21/ncci-edit-ribbon-opportunity-to-clear-up-coding-confusion-over-dry-needling