What insurance policy changes affect CPT 97813?

There are 10 tracked policy changes affecting CPT 97813, including updates from Missouri Medicaid (MO HealthNet), Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 97813?

Payers that have issued tracked updates for CPT 97813 include: Missouri Medicaid (MO HealthNet), Aetna.

How do I get notified when CPT 97813 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 97813. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 97813?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

97813 — Acupuncture treatment with electrical stimulation applied to the needles during the first 15 minutes of the session.: Insurance Policy Changes

97813 Insurance Policy Changes

CPT 97813, in plain terms, covers Acupuncture treatment with electrical stimulation applied to the needles during the first 15 minutes of the session. CPT 97813 is referenced in 10 tracked payer policy changes from Missouri Medicaid (MO HealthNet) and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 97813 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Medium impact

Diabetic Neuropathy: Selected Treatments (CPB 0729, reviewed 2026-10-21)

Aetna·Identified Oct 25, 2026

Aetna's CPB 0729 policy (reviewed 2026-10-21) establishes medical necessity criteria for diabetic neuropathy treatments, covering percutaneous electrical stimulation (limited to ≤4 weeks) and dorsal column stimulation (per CPB 0194 criteria), while classifying 30+ interventions as experimental/investigational—including acupuncture, stem cells, nerve blocks, surgical decompression, and topical ketamine. This is a restatement of established coverage policy with no stated effective date change; billing teams should verify current applicability and confirm whether their practice has implemented these coverage determinations.

97813 Insurance Policy Changes

Complementary Health and Alternative to Chronic Pain Management

Acupuncture and Dry Needling (CPB 0135, reviewed 2026-03-25)

Neurogenic Bladder: Selected Treatments (CPB 0852, reviewed 2025-12-23)

Dry Eyes (CPB 0457, reviewed 2026-07-29)

Tinnitus Treatments (CPB 0406, reviewed 2026-07-10)

Enuresis (CPB 0431, reviewed 2026-07-01)

Alzheimer's Disease: Experimental, Investigational, or Unproven Treatments (CPB 0788, reviewed 2025-11-19)

Electrical Stimulation for Nausea, Vomiting, Motion Sickness and Other Selected Indications (CPB 0676, reviewed 2025-10-07)

Guillain-Barre Syndrome Treatments (CPB 0732, reviewed 2026-10-21)

Diabetic Neuropathy: Selected Treatments (CPB 0729, reviewed 2026-10-21)