It’s safe to say that trigger point dry needling has been getting under our skin (pun very much intended). That’s because we get a lot of questions about billing for dry needling—specifically, about whether physical therapists are actually allowed to bill for the practice—and there isn’t an easy answer. In fact, there isn’t an answer at all. Here’s why:
The Scope-of-Practice Problem
Dry needling has taken some heat.
Back in 2009, the American Academy of Orthopedic Manual Physical Therapists (AAOMPT) decided that dry needling fell within the scope of PT practice:
Dry needling is a neurophysiological evidence-based treatment technique that requires effective manual assessment of the neuromuscular system. Physical therapists are well trained to utilize dry needling in conjunction with manual physical therapy interventions. Research supports that dry needling improves pain control, reduces muscle tension, normalizes biochemical and electrical dysfunction of motor end plates, and facilitates an accelerated return to active rehabilitation.
And the American Physical Therapy Association agrees with that statement. So far, so good—right? Wrong. Over the past several years, dry needling has taken a lot of heat from those in the medical community. Providers who are pro-dry needling tout its many benefits, including—as Jan Dommerholt mentions in this Journal of Manual and Manipulative Therapy article—reducing pain and improving range of motion. However, detractors are pulling out all the stops to stop PTs from dry needling—everything from claiming that it doesn’t fall under the PT scope of practice (as a result of its perceived similarity to acupuncture) to saying that there’s not enough evidence to support its effectiveness.
To make matters even more messy, different states have fallen on opposing sides of the argument, so depending on where you practice, you may or may not be able to legally provide the service—regardless of your own personal stance on the issue. (Scroll down for a chart that shows which states do and do not allow physical therapists to practice dry needling.)
The Billing Conundrum
Some private payers won’t pay for the service.
Even if you are legally able to provide dry needling under your state practice act, Eric Ries explains in this PT in Motion article that some private payers—such as BlueCross BlueShield of Maryland—simply won’t pay for the service, claiming that it is “experimental.” (Although I doubt these coverage denials are unique to BC/BS health plans, in my research for this article, I came across a note from BlueCross BlueShield of South Carolina announcing that as of August 1, 2016, it will no longer cover dry needling because it is now considered “investigational.”)
CMS added CPT codes for dry needling—but Medicare won’t pay for the service, either.
The 2020 final rule included the addition of two dedicated dry needling CPT codes:
- 20560: Needle insertion(s) without injection(s), 1 or 2 muscle(s)
- 20561: Needle insertion(s) without injection(s), 3 or more muscle(s)
Unfortunately, as we explained here, “CMS declined to finalize these codes as ‘always’ or ‘sometimes’ therapy services because, as CMS so delicately put it, ‘dry needling services are non-covered unless otherwise specified through a national coverage determination (NCD).’ So, even though therapists finally have some dedicated dry needling codes, Medicare will not pay for them.”
The Imperfect Solution
For the time being, there doesn’t appear to be a great solution to these problems. However, there are three things you should do if you want to provide—and receive payment for—dry needling:
1. Check your state practice act.
First and foremost, make sure that you’re legally able to perform dry needling under your state practice act. That means two things:
- dry needling must fall within the scope of physical therapy practice in your state, and
- you must meet the educational and training requirements necessary to perform the service.
Here’s the breakdown of states that expressly allow—and disallow—dry needling as of 2014 (according to the APTA):
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*Oregon stated that dry needling will most likely fall within the scope of practice for physical therapists—eventually. However, the state has asked practitioners not to perform the service until it can set training and educational guidelines.
2. Ask your payers.
In the above-cited PT in Motion article, Justin Elliott—the APTA’s director of state government affairs—said, “APTA’s advice always is to first determine the insurer’s policy toward dry needling, then, if the company will pay for it, to ask what code they want you to use.” This advice also appears in the above-cited APTA resource paper: “Physical therapists should check with the insurance payor to see if it has issued any policies regarding billing of dry needling.” In other words, this is a situation where it pays to ask for permission—not forgiveness.
3. Consider cash-pay.
To avoid dry needling billing complications altogether, you may want to consider providing this service on a cash-pay basis. In the PT in Motion article, Dommerholt cautions that billing insurance companies for dry needling is a “hot potato”—one that he avoids altogether because his private practice is 100% cash-based. (For more information on how to provide cash-pay services, check out this blog post.)
Until the CPT code set evolves to include codes that describe dry needling—and the states align on the legality of the practice—it appears that physical therapists will continue to have to jump through hoops in order to provide (and receive payment for) this skilled intervention. Where do you stand on the issue? Tell us your thoughts in the comment section below.
Still have questions about billing for dry needling—or other common PT services? Check out this PT billing FAQ.
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