Can I get acupuncture covered by no-fault insurance?
- caulocare
- Mar 16
- 3 min read
No-fault insurance, also known as Personal Injury Protection (PIP), covers medical expenses for individuals injured in automobile accidents, regardless of who was at fault. Many states recognize acupuncture as a covered treatment under no-fault insurance, especially for injuries related to pain management, soft tissue injuries, and rehabilitation.
Steps to Get Acupuncture Covered by No-Fault Insurance
Verify State-Specific Laws
Each state has different rules regarding what treatments are covered under no-fault insurance.
Some states explicitly list acupuncture as an approved treatment, while others may require a case-by-case review.
Common states where acupuncture is covered under PIP include New York, New Jersey, Florida, and Michigan.
Confirm Coverage with the Insurance Provider
Contact the no-fault insurance provider to confirm that acupuncture is covered under the policy.
Ask about specific billing codes, required documentation, and provider credentialing.
Obtain a Medical Referral (If Required)
Some insurance companies require a doctor’s referral stating that acupuncture is medically necessary.
This can come from a primary care physician, pain management specialist, or chiropractor.
The referral should include the diagnosis code (ICD-10) and recommended treatment duration.
Ensure You Are an Approved Provider
No-fault insurance companies may require acupuncture providers to be licensed and registered with their network.
If you are an acupuncturist, check if you need to credential with specific insurance carriers.
Document and Submit Proper Billing Codes
Use the correct Current Procedural Terminology (CPT) codes for acupuncture:
97810 – Initial acupuncture, 15 minutes
97811 – Additional 15 minutes
97813 – Initial electro-acupuncture, 15 minutes
97814 – Additional electro-acupuncture, 15 minutes
Include the ICD-10 diagnosis code corresponding to the patient’s injury (e.g., whiplash, sprains, or nerve pain).
Submit Claims on Time
No-fault insurance has strict deadlines for submitting claims (usually 30 to 45 days from the date of treatment).
Keep detailed patient records, including SOAP notes (Subjective, Objective, Assessment, Plan), to justify treatment.
Claims should be submitted via CMS-1500 forms if you are billing directly.
Handle Denials and Appeals
If a claim is denied, request a written explanation from the insurer.
You can appeal by submitting additional documentation or requesting a peer review.
If necessary, consult a medical billing expert or an attorney specializing in no-fault claims.
For Acupuncture Clinic Owners
Since you own an acupuncture clinic, accepting no-fault insurance can be a great way to expand your patient base. Here are some key things to keep in mind:
✅ Get Credentialed – Register with insurance companies that cover no-fault claims.
✅ Train Staff on Billing – Ensure your front desk and billing staff are familiar with PIP billing rules.
✅ Keep Documentation Organized – No-fault claims often require detailed progress notes and justifications.
✅ Monitor Claim Status – Follow up on unpaid or denied claims quickly to avoid revenue loss.
✅ Know Legal Requirements – Some states have specific rules for acupuncture in personal injury cases, such as treatment caps or provider restrictions.
This information is only educational and should not be construed as medical advice.
Everything must be balanced, and the suggestions may not apply to you.
A specialist doctor should be consulted for any medical advice or diagnosis.
Acupuncture near me at Forest Hill, New York
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Dr. Phumlarp Caulo LA,c, MAc. OM, DAHM
Doctor of Acupuncture/Chinese Medicine
Caulo Care Acupuncture
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