Spokane Acupuncture, LLC
General Billing Information: Our office will submit billing to most in-network or out-of-network health insurance policies that provide coverage for acupuncture. We will not submit billing to secondary health insurance policies or supplemental health insurance policies unless they are contracted with us to do so.
In-Network Insurance Billing Information:
Step 1 - Submitting the Claim: Insurance claims are delivered electronically, or in some cases by mail, from the provider’s office to the insurance company after each visit. Washington state law generally allows health insurance companies up to 30 days to process a claim after they receive it.
Step 2 - Receiving the E.O.B.: The insurance company will send the patient and the provider’s office an E.O.B., or explanation of benefits, after they process the claim.
Step 3 - Patient Billing: The provider’s office will send the patient a statement reflecting any outstanding balance for services not covered by the insurance company, or paid by the patient during their visit.
Understanding Insurance Coding and Billing: The E.O.B. shows CPT codes for services, procedures, and products in a format required by the insurance company.
Single visits often require multiple CPT codes to comply with the insurance company’s requirement to specify services, procedures, products, quantity, and time. Example: A 90 minute “new patient” visit will often include 3 or more billing codes.
Patient evaluation and assessment codes are separate from procedures, services, and products. Patient evaluation and assessment is performed at the initial visit, and then periodically to re-evaluate progress or to indicate that a new or different condition is being evaluated, assessed, and treated.
Procedures often require two or more codes to indicate procedure type and time or quantity.
Understanding the Insurance Company's E.O.B.: The E.O.B. shows the amount billed for each code, the in-network discount for each code, and the portions of the bill the patient and insurance policy are responsible for.
The amount billed for each code is based on the “usual and customary rate” (UCR) in the geographic location of your provider’s office. UCRs for any code can be found at www.fairhealthconsumer.org.
E.O.B. statements usually show an “adjustment” or "allowed" amount, which is a contracted discount between the provider and the insurance company.
The most common CPT codes used by East Asian Medicine Practitioners / Licensed Acupuncturists are:
97810, 97811, 97813, 97814, 97140, 97112, 97032, 97026, 99201, 99202, 99203, 99211, 99212, 99213