The Good Faith Estimate (GFE)

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Patients frequently ask, "Do you take insurance?"  Yes and no.  While acupuncture is covered under many insurance policies, the varied aspects of Chinese Medicine (such as life coaching, food and nutrition counseling, on-site home assessments and energy services) may not be.  

Some patients have acupuncture reimbursed by their insurance company.  To help make your health a priority, I am able to take FSA/HSA debit cards.  Most FSA/HSA programs cover all aspects of care (and rarely ask for details).  

If you wish to have acupuncture covered under your insurance policy, here are some general steps to make the process of reimbursement easier for you.

Step 1

Call your insurance provider and ask if acupuncture, Chinese Medicine, food/nutrition coaching, life coaching is covered under your policy.  If it is, there will be a CPT Code that designates the therapy.  CPT Codes are descriptions of services.  Ask them to provide you with the codes they reimburse for and how many of each code per session (ie 97810 x 1; 97811 x 2).  Below are some common codes used for acupuncture and Chinese Medicine services.

• CPT Code 97810 Initial First 15 Minutes of acupuncture without electrical stimulation 
• CPT Code 97813 Initial 15 minutes of acupuncture with electrical stimulation  
• CPT Code 97811 Each Add'l 15 minutes of acupuncture without electrical stimulation 
• CPT Code 97814 Each Add'l 15 minutes of acupuncture with electrical stimulation 
• CPT Code 97016 Cryotherapy
• CPT Code 97140 Manual Therapy
• CPT Code 97802/97803 Nutritional Coaching 
• CPT Code 0591T/0592T Health Coaching (Category III so may not reimburse)

Step 2

Talk to your prescribing physician.  This may be a Primary Care Physician (MD or DO), orthopedist, oncologist, surgeon, OB-GYN, physician's assistant (PA), nurse practitioner (NP), or psychiatrist.  Tell them about your area of concern and ask them if they think acupuncture and/or Chinese Medicine is a potential solution or support medicine to their care.  If so, tell them that you would like to try my services.  

Next, they need to write a prescription using a CPT Code and a Diagnosis Code, known as an ICD-10 Code, and designate the number of sessions (ie. 5 sessions of 60 minute acupuncture or 5 sessions of 90 minute Chinese Medicine life coaching or food/nutrition counseling, etc).   If your prescribing physician has questions about how my service can help, they are welcome to call, text or email me at contact@phoenixmoonacupuncture.com. 

Note:  Make sure you hold on to the prescription.  You may need to submit it for reimbursement.

Step 3  

Make an appointment for an Initial Health Assessment and place in the appointment notes section that you have received a prescription and approval for services from your insurance company.  List the CPT Codes and any Diagnostic ICD-10 Codes received and the number of approved sessions. 

Once we decide on your care plan, I would suggest you booking all of your sessions at one time.  I see patients two days per week and get booked out.  

Step 4

After your designated number of sessions, you will request an invoice detailing the session using the appropriate CPT Codes.  The invoice will be marked "Paid In Full" with the appropriate CPT and ICD-10 Codes. You must then submit this invoice along with your prescription to your insurance company.  

Delivery of your superbill invoice may be up to two weeks.  Depending on your insurance company, reimbursement may take awhile and you may not be reimbursed in full for the amount you paid out as some companies have a max amount of reimbursement for each code.  

First drafts of superbill invoices are complimentary.  Any changing of codes or other alterations requiring additional invoices or changes are charged a $120 admin fee per invoice to cover my time.

Step 5

If you have not received a referral from your physician for my service but still wish to attempt reimbursement, please complete Step 1, 3-4 above.  Note the diagnosis information below.  No superbill invoices will be provided unless you have received pre-approval by your insurance company including their approved CPT Codes.  

Note:

Proprietary services I have created and some of the techniques that I practice as part of your care plan, will not, and may not, have an applicable insurance code and, therefore, may not be able to be reimbursed.  The care I provide here is unique.  I urge you to consider the cost of not working with me compared to the cost of working with me with partial, or no, reimbursement and make your determinations from there.  

Chinese Medicine and acupuncture diagnoses do not follow the diagnoses of Western Medical doctors.  Part of our skill is in the correlation of Western diagnoses to our own terminology and methods.  If no ICD-10 Code (diagnosis code) is provided, I will do my best to find a diagnosis code that accurately describes your care.   

I accept Flex Plans (FSA) and HSA plans, cash, all major credit cards (fees additional) and Venmo.   A valid credit card on file is required to schedule sessions.  Failure to keep a current card on file may suspend your ability to schedule.