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Independence Blue CrossMedicare Advantage · Billing Codes · Medical Policy · Pain Management, Physical Therapy, Orthopedics +2 moreMedium impact

MA12.004e, Acupuncture

Act
by Jan 1, 2025
Effective date
Jan 1, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross Medicare Advantage reissued acupuncture policy MA12.004e with a code update effective 01/01/2025. CPT codes 97811 and 97814 have been 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 improvement shown, max 20 annually), requires modifier KX for sessions 13-20, and continues to exclude all other indications.

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What to do

by Jan 1, 2025 · 6 steps
01Billing team must ensure all acupuncture claims for CPT codes 97811 and 97814 are billed according to the revised policy.
02Verify that: (1) claims for acupuncture sessions 1-12 within a 90-day period are submitted without prior authorization if medical necessity criteria are met; (2) sessions 13-20 include mandatory modifier KX on claims; (3) no claims exceed 20 sessions annually; (4) all claims include documentation of chronic low back pain diagnosis lasting 12+ weeks with nonspecific etiology (no systemic, inflammatory, infectious disease, surgery-related, or pregnancy-related cause).
03Update billing system to enforce the 12-session/90-day limit and 20-session annual maximum.
04Reject or flag claims for acupuncture for any indication other than chronic low back pain, as these are non-covered.
05Train billing staff on modifier KX requirements for sessions 13-20.
06Verify that provider documentation supports medical necessity before claim submission; missing documentation will result in denials.

Codes mentioned

97811978149781097813S89302056020561

Original notice

MA12.004e, Acupuncture
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
MA12.004e, AcupunctureMediumEffective Jan 1, 2025 · Medical PolicyMA12.004e, AcupunctureMediumEffective Jan 1, 2025 · Medical Policy12.00.01i, AcupunctureMediumEffective Jan 1, 2025 · Medical Policy12.00.01i, AcupunctureMediumEffective Jan 1, 2025 · Medical PolicyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesPain ManagementPhysical TherapyOrthopedicsFamily MedicineGeneral PracticeCode 97811Code 97814Code 97810Code 97813Code S8930Code 20560Code 20561

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