Pricing and Insurance
Insurance
&
Acupuncture
Benefits
We strongly recommend contacting your insurance provider prior to your visit to fully understand your acupuncture benefits. Obtaining accurate and detailed information directly from your insurance company will help you prepare for any costs and ensure a smooth experience.
When speaking with your insurance representative, please specify that you will be seeing an acupuncturist and ask about your 2026 acupuncture benefits, including:
Coverage details and out-of-pocket costs
Visit limitations or annual maximums
Any excluded conditions or diagnoses
Please note that evaluations are billed separately from acupuncture treatments and may be subject to different coverage and costs. Be sure to ask about benefits and potential charges for both new and returning patient evaluations performed by an acupuncturist.
Additionally, if your treatment plan includes cupping (CPT code 97140), please be aware that this service is not always covered or billable to insurance, depending on your specific plan.
Taking a few minutes to verify this information in advance can help avoid unexpected expenses and give you greater peace of mind before your appointment.
Insurance terminology
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This is the amount we bill your insurance for each service.
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This is the sum of what will be paid for each service by the insurance company and/or by the patient. Your insurance determines the allowed amount.
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This is the difference between the billed amount and the allowed amount. You are not responsible for this amount unless you have agreed to pay for a specific service that your insurance does not cover.
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This is the amount you owe to the provider who performed the service.
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This is an amount that you owe to the provider before your insurance pays on services you receive.
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This is the most you will have to pay as patient responsibility in a given year. Once you have met your Out of Pocket Maximum, insurance will pay the provider the full allowed amount.
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A set fee that your insurance company determines according to your plan for a given service paid to the provider. Usually between $10 and $60, this amount may be applied to your deductible or separate from your deductible, as well as your out of pocket maximum. This amount is paid at the time of service.
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A percentage of the allowed amount your insurance company determines according to your plan. Typically between 10%-40%, this amount is usually applied to your deductible and out of pocket maximum. This amount is reported to the provider when your insurance company has determined the validity and outcome (called adjudication) of the claim. This amount is paid to the provider.
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Includes what the insurance paid the provider and the patient responsibility due to the provider.
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The number of visits allowed in a given period for a specific benefit or a group of benefits. Benefits which may be included in a visit limit are therapies such as occupational therapy, physical therapy, acupuncture, and massage. It is the patient’s responsibility to keep track of their usage of visits. Once the visit limit has been reached the patient is responsible to pay for services at the time of service rate.
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Your insurance may require a referral from your physician. Please check with your insurance to see if a referral is required prior to scheduling an appointment. If a referral is required and services are performed without a referral, the treatments will be paid out of pocket at time of service rates.
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Your insurance may require authorization. Please check with your insurance to see if authorization is required prior to scheduling an appointment. We will help to obtain the authorization, if needed. Typically, authorizations are for a limited time and or number of treatments. If authorization is required and services are performed outside of the authorization, the treatments will be paid out of pocket at time of service rates.
Insurance examples
We highly recommend that you contact your insurance company to be fully informed of your acupuncture benefits through your insurance. Getting accurate and complete information from your insurance policy provider/company prior to your visit is crucial for your care and your peace of mind. Please take time to give your insurance company a call and state that you are going to see "acupuncturist" so that they will let you know your 2026 acupuncture treatment-related insurance benefits in detail including costs you may incur, limitation of visits, and diagnoses that are considered excluded.
Example 1:
Andrea ‘s insurance has a 20% coinsurance for office visits (evaluations) which will be subject to meeting deductible, if not satisfied. She has an acupuncture benefit which allows for 12 acupuncture visits per calendar year with a $25 copay. Manual Manipulation falls under her physical therapy benefit which is a $10 copay with 30 visits per calendar year.
Example 2:
Yun’s insurance has an acupuncture benefit which allows for 10 visits per calendar year, but only covered when used in lieu of anesthesia. Yun’s acupuncture benefit does not cover our services. Yun will be paying time of service.
Example 3:
Johan has a $25 copay for office visits, not subject to deductible. George has unlimited acupuncture visits with $30 copay, but medical necessity must be proven.
Our Rates and CPT Codes:
Rates that we charge your insurance (subject to allowed amount and contract obligations):
CPT 99203 Initial Evaluation and Management (Office Visit) $302
CPT 99213 Return Evaluation and Management (Office Visit) $230
CPT 97810 and 97811 Manual Acupuncture $194
CPT 97813 and 97814 Electro Acupuncture $231
CPT 97140 Manual Therapy (Cupping) $48
CPT 97110 Therapeutic Exercise $55
