Q&A: Medicare coverage of acupuncture

Wednesday, April 4, 2018

Q: We are having an internal discussion regarding the correct modifier to use for acupuncture. Our discussion is revolving around whether there is a difference between statutorily excluded and non-covered services. There are three sides to our discussion:

  • There is a National Coverage Determination (NCD) stating acupuncture is not covered, and by virtue of this NCD it can be considered statutorily excluded (requiring modifier GY)
  • Acupuncture is not strictly defined in the billing manual. It is only mentioned as a non-covered and therefore modifier GY is not appropriate
  • Statutorily excluded and non-covered services can both be billed with modifier GY

What are your thoughts on this?

A: In January 2017, CMS published a Medicare Learning Network article called "Items and Services Not Covered under Medicare." It lists four categories of services that are not covered. These are:

  • Not medically necessary. One of the examples they list is acupuncture.
  • Non-covered services. These services appear to be the items you might think are excluded by law (services provided outside the US, cosmetic surgery, etc.).
  • Bundled services.
  • Services reimbursed by other organizations.

Our practice would be to have the patient sign an ABN to be safe, and then bill the acupuncture without the modifier –GY.

Note: This question can be found in the coverage section on the NAHRI Forums where you can find answers to questions on a variety of topics from billing and claims to compliance to reimbursement. This question was answered by Terri Rinker, MT (ASCP), MHA, revenue cycle director, Community Hospital Anderson in Anderson, Indiana.