Acupuncture with one or more needles and no electrical stimulation, covering the first 15 minutes of personal one-on-one contact.
- Medicare
- $48.10
- Work RVU
- 0.61
- Global, days
- Region
- Spine
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Diagnosis and duration of pain (12 weeks or more for Medicare low back pain)
- Needle points used
- Personal one-on-one contact time
- No electrical stimulation in the initial block
- Session count within the coverage period
- Patient response and improvement
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
97810 is the first 15 minutes of acupuncture without electrical stimulation. Additional 15-minute blocks use 97811. If any needles in the initial block are stimulated electrically, the initial code is 97813 instead, and only one initial code is billed per day.
Medicare covers acupuncture only for chronic low back pain under a national coverage determination: pain lasting 12 weeks or longer, with no identifiable systemic cause such as metastatic, inflammatory, or infectious disease, and not linked to surgery or pregnancy. Coverage is up to 12 sessions in 90 days, with 8 more if the patient improves, capped at 20 per year. The service must be delivered by a physician, or by a PA, NP, or other qualified provider meeting the licensing rules under supervision. Chiropractors cannot bill Medicare for it.
Ortho and spine practices offering acupuncture usually do it through a credentialed provider in a pain or PM&R division. Time is face-to-face needle time, not resting time with needles in place. Document the diagnosis, points, minutes of contact, and response.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (0.61) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (1.44) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.61 |
| Practice expense RVU | 0.79 |
| Malpractice RVU | 0.04 |
| Total RVU | 1.44 |
| Medicare national rate | $48.10 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $48.10 |
HOPD (APC 5731) Hospital outpatient department | $29.55 |
Common denial reasons
The recurring reasons claims for CPT 97810 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Medicare claim for a diagnosis other than chronic low back pain
- Session limit exceeded
- Provider not eligible to bill Medicare acupuncture
- Billed with 97813 as a second initial code
- No improvement documented for sessions beyond 12
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Does Medicare cover acupuncture?
02Can 97810 and 97813 be billed the same day?
03Can a chiropractor bill Medicare for 97810?
Sources & references
Editorial content was developed using the following public sources.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/medicare/payment/fee-schedules/physician
- 03Medicare NCD 30.3.3 Acupuncture for Chronic Low Back Pain
Mira Scribe
Mira Scribe records the diagnosis, pain duration, points, and contact time, which covers the Medicare questions for chronic low back pain acupuncture.
See how Mira captures CPT 97810 documentation