Summary
Independence Blue Cross reissued MA12.004e acupuncture policy with code updates effective 01/01/2025. CPT codes 97811 and 97814 were revised. The policy maintains coverage for up to 12 acupuncture sessions in 90 days for chronic low back pain (with up to 8 additional sessions if improving, maximum 20 annually), requires KX modifier for sessions 13-20, and covers only chronic low back pain conditions.
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What to do
Action · 5 steps
01By 01/01/2025: Billing team must verify that the billing system correctly maps CPT codes 97811 and 97814 per the revised policy.
02Ensure the system enforces the 12-session limit in 90 days (with conditional 8 additional sessions), the 20-session annual maximum, and requires KX modifier for sessions 13-20.
03Update claim edit rules to deny acupuncture claims for non-chronic low back pain indications or for sessions exceeding limits.
04Audit any pending claims from 01/01/2025 forward to confirm compliance.
05Train billing staff that sessions 13-20 require KX modifier submission or claims will be denied.
Codes mentioned
97811978149781097813S89302056020561
Original notice
MA12.004e, Acupuncture
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
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