2026 Acupuncture Billing & Payment Updates

Coverage Limits, Documentation, and Compliance in 2026

Table of Contents

Overall, 2026 brings no expansion of Medicare-covered indications for acupuncture. However, documentation standards, visit limits, and payer scrutiny remain strict, making compliance and workflow discipline essential.

1. Medicare Coverage for Acupuncture in 2026

Medicare coverage for acupuncture remains limited and diagnosis-specific in 2026.

Medicare continues to cover acupuncture only for Chronic Low Back Pain (CLBP).

CLBP must meet Medicare’s definition:

  • Pain duration of 12 weeks or longer
  • No identifiable systemic cause (e.g., infection, malignancy, fracture)
What this means for you:
Claims billed for diagnoses outside Medicare-defined CLBP remain non-covered and are subject to denial or recoupment.

2. Covered CPT Codes and Visit Limits

Medicare coverage continues to apply to the following codes:

  • 97810 – Initial acupuncture treatment
  • 97811 – Subsequent acupuncture treatment

Visit limits remain unchanged:

  • Up to 12 visits in 90 days
  • An additional 8 visits allowed only if documented improvement is demonstrated
  • Maximum of 20 visits per calendar year
What this means for you:
Exceeding visit limits or failing to document improvement within the first 90 days will result in automatic denials.

3. Medicare Payment Rates – 2026

  • Acupuncture services receive a modest payment increase aligned with the overall Medicare conversion factor update for 2026.
  • No new valuation changes were introduced for acupuncture CPT codes.
What this means for you:
While reimbursement is slightly improved, revenue growth depends primarily on accurate eligibility screening and strict visit tracking, not increased rates.

4. Documentation Requirements (High-Risk Area)

Medicare continues to closely review acupuncture claims for:

  • Clear documentation of:
    • Chronic low back pain diagnosis
    • Functional limitations
    • Measurable improvement
  • Evidence that treatment is:
    • Medically reasonable
    • Time-limited
    • Discontinued when improvement plateaus
What this means for you:
Generic notes, repeated templates, or lack of outcome tracking significantly increase audit and recoupment risk.

5. Maintenance Care Remains Non-Covered

Acupuncture for:

  • General wellness
  • Stress relief
  • Maintenance or preventive care

remains non-covered by Medicare

What this means for you:
  • Clearly identified
  • Supported by proper ABNs
  • Billed correctly to avoid improper Medicare claims

6. Commercial & Medicare Advantage Plans

Coverage policies for acupuncture vary widely among commercial payers and Medicare Advantage plans.

Many plans:

  • Impose stricter visit caps
  • Require prior authorization
  • Limit covered diagnoses
What this means for you:
Payer-specific verification is critical before initiating treatment to prevent denials and patient dissatisfaction.

7. Patient Responsibility & Collections

The Medicare Part B deductible increases to $283 in 2026.

What this means for you:
Higher patient responsibility early in the year may impact collections. Transparent financial discussions and point-of-service collections are increasingly important.

Key Takeaway

2026 reinforces a consistent message for acupuncture practices:

Coverage is narrow, documentation must be precise, and visit limits must be enforced.

Practices that:

will be best positioned to avoid denials, audits, and recoupments.

Our team will support you with:

Please contact us if you would like a practice-specific acupuncture billing impact review or assistance preparing your workflows for 2026.

In Touch Billing Success Stories and Track Record

We have helped grow thousands of private practices over the years with a combination of software, workshops, and training programs. We recognize that basic elements like an EMR, billing software and a clearing house by themselves do not build a successful practice. They are just components of the bigger picture.

What you need is a billing service and a team that can help you with compliance and clinical documentation requirements. When you put great software in the hands of outstanding, dependable clinicians and billers, you’ll build a successful practice.

In December 2025 alone, our billing software has been used to process over $1 billion in collections and millions of insurance claims from thousands of payers in every state across the country. We are based in Denville, NJ and our billing staff is located in the United States and overseas, to help you lower your costs and maximize your revenue.

In 10 minutes, we’ll show you how In Touch Billing can slash your billing costs and boost revenue.

Schedule this no-obligations call. Ask for a FREE billing audit to learn new ways to increase revenue and reduce denials.

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In 10 minutes, we’ll show you how In Touch Billing can slash your billing costs and boost revenue.

Schedule this no-obligations call. Ask for a FREE billing audit to learn new ways to increase revenue and reduce denials.

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