Insurance Coverage for Dry Needling
Dry needling is a relatively new treatment that is not yet covered by all insurance companies. However, some insurance companies are beginning to cover dry needling, especially when it is used to treat chronic pain.
There are a few different types of insurance coverage that may cover dry needling. These include:
- Medical insurance: Some medical insurance plans may cover dry needling if it is prescribed by a doctor and used to treat a medical condition, such as chronic pain.
- Physical therapy insurance: Physical therapy insurance may cover dry needling if it is performed by a physical therapist and used to treat a musculoskeletal condition, such as a sports injury.
- Workers’ compensation insurance: Workers’ compensation insurance may cover dry needling if it is used to treat a work-related injury.
Some examples of insurance companies that typically cover dry needling include:
- Blue Cross Blue Shield
- Aetna
- Cigna
- UnitedHealthcare
If you are considering dry needling, it is important to check with your insurance company to see if it is covered. You can also ask your doctor or physical therapist to help you determine if dry needling is right for you.
Factors Affecting Coverage
Insurance coverage for dry needling depends on various factors, including the patient’s diagnosis, the provider’s credentials, and the treatment setting.
Patient’s Diagnosis
Dry needling is generally covered for specific medical conditions, such as musculoskeletal pain, trigger points, and chronic pain. The patient’s diagnosis will determine whether the treatment is considered medically necessary and thus eligible for coverage.
Provider’s Credentials
Insurance companies typically require that dry needling be performed by a licensed and certified healthcare professional. This may include physical therapists, chiropractors, or acupuncturists who have received specialized training in dry needling.
Treatment Setting
Coverage may also vary depending on the setting where the treatment is provided. Dry needling is typically covered when performed in a clinical setting, such as a physical therapy clinic or doctor’s office. Coverage may be limited or excluded for treatments performed in non-medical settings, such as gyms or spas.
How to Determine Coverage
Determining insurance coverage for dry needling involves a few key steps:
Contact the Insurance Provider
The most reliable way to ascertain coverage is to directly contact the insurance provider. Patients can call the customer service number on their insurance card or access their online portal to inquire about specific coverage details.
Billing and Coding
Billing and coding are crucial for dry needling to be covered by insurance. Using the correct codes ensures accurate reimbursement and streamlines the claims process.
CPT Codes
The primary billing code for dry needling is CPT code 20552, which represents “percutaneous electrical neuromuscular stimulation (PENS), needle electrode placement, percutaneous, each 15 minutes.”
Additional codes may be used to indicate the specific region being treated, such as:
- CPT code 20553: PENS, needle electrode placement, percutaneous, each additional 15 minutes
- CPT code 20560: PENS, needle electrode placement, intramuscular, each 15 minutes
- CPT code 20561: PENS, needle electrode placement, intramuscular, each additional 15 minutes
Out-of-Pocket Costs
If dry needling is not covered by your insurance, you may have to pay for it out-of-pocket. The cost of dry needling can vary depending on the provider, the number of sessions needed, and the location of the treatment.
Here are some tips for minimizing your out-of-pocket costs for dry needling:
Using a Health Savings Account (HSA)
- An HSA is a tax-advantaged savings account that can be used to pay for qualified medical expenses, including dry needling.
- Contributions to an HSA are made on a pre-tax basis, which means they are deducted from your paycheck before taxes are calculated.
- Withdrawals from an HSA are tax-free if they are used for qualified medical expenses.
