It’s not easy to run an acupuncture clinic without losing any revenue. You have to manage care for your patients, handle schedules, order supplies, and keep up with regulations; all these tasks put billing aside. This is the reason that most of the acupuncture clinics lose money without even knowing about it.
Most practices face underbilling unintentionally and think that they are billing correctly. But the problem is they lost their revenue due to small mistakes, outdated habits, misunderstood codes, and insurance rules that keep changing. These mistakes not only cause the revenue to be lost but also cause claims to be denied.
That’s why it is important to know the reasons for underbilling, what revenue you are missing, and how to fix them. So let’s discuss all these factors in detail and show you how you can improve your clinic’s financial health.
What Does Underbilling Actually Mean in Acupuncture?
Underbilling happens when a clinic provides services but doesn’t bill for them correctly or doesn’t bill for them at all. Sometimes it can be due to using the wrong CPT code. Other times, it’s missing add-on units, modifiers, or documentation that would support higher reimbursement. In acupuncture insurance billing, small errors can cause the biggest problems. One missed unit per visit doesn’t seem like a big deal—until you realize it’s happening hundreds of times a year. And insurance companies won’t call you to tell you you’ve underbilled. They’re happy paying less.
The Most Common Reasons Acupuncture Clinics Underbill
Confusion Around Acupuncture CPT Codes
This is probably the biggest issue. Many acupuncture clinics face difficulties in handling acupuncture CPT codes like:
- 97810 – Initial acupuncture without electrical stimulation (first 15 minutes)
- 97811 – Each additional 15 minutes without stimulation
- 97813 – Initial acupuncture with electrical stimulation
- 97814 – Each additional 15 minutes with stimulation
These codes look similar and cause big confusion for coders, and they make mistakes like:
- They bill only the initial code and forget the add-on units
- They don’t track time accurately
- They use the wrong code when electrical stimulation is involved
Missing just one add-on unit per session means consistent revenue loss, and it adds up faster than you think.
Not Billing for Time Correctly
Acupuncture billing is time-based, which makes it different from other specialties and makes things more complex. If your provider spends 38 minutes with a patient but you only bill for 15 minutes, you’re underbilling simply. Many clinics:
- Don’t document start and stop times clearly
- Estimate time instead of tracking it
- Play it safe by billing fewer units to avoid audits
But remember that underbilling doesn’t protect you from audits; it costs you money and affects the overall revenue cycle management of your practice.
Skipping Billable Services Without Realizing It
Acupuncture sessions do not always include needle placement. Depending on payer rules, clinics can be missing reimbursement for:
- Electrical stimulation
- Re-evaluations
- Therapeutic exercises
- Heat or manual techniques (when allowed and documented properly)
Insurance rules vary for each service, and that’s the reason that many clinics avoid billing anything beyond basic acupuncture—even when it’s allowed. This restriction and hesitation lead to lost revenue.
Poor or Incomplete Documentation
Documentation plays an important role in a successful claim submission. And most of the clinics lack this, which impacts the reimbursement. Even when services are provided, weak documentation can force billers to downcode or not bill at all. Common documentation problems include:
- No clear treatment plan
- Missing medical necessity
- No link between diagnosis and services
- Generic SOAP notes copied from previous visits
Insurance companies don’t pay based on what you did. They pay you based on what you have documented.
Fear of Denials and Audits
A lot of acupuncturists underbill because they’re worried about getting denied or audited. So they:
- Bill fewer units than provided
- Avoid certain CPT codes entirely
- Skip re-evaluations
- Don’t use modifiers when needed
The fear of audit is understandable but this approach is not good for your practice. Accurate billing with proper documentation is safer than consistently underbilling and hoping for the best.
Lack of Insurance Verification
Another major cause of revenue leakage is not verifying benefits properly. Without clear insurance verification, clinics can:
- Assume acupuncture isn’t covered
- Undercharge patients
- Miss the authorization requirements
- Fail to bill secondary insurance
Accurate eligibility checks upfront can mean the difference between partial payment and full reimbursement.
Outdated Billing Knowledge
Acupuncture billing rules don’t stay the same. Insurance policies regularly change. Coverage expands or tightens. And CPT guidelines get updated. Clinics that rely on:
- Old cheat sheets
- Word-of-mouth advice
- “How we’ve always done it”
are often underbilling without realizing it. Getting updated can save you from major problems.
The Real Cost of Underbilling an Acupuncture Practice
Underbilling does not seem to be a major problem. It’s quiet. And over time, it becomes more expensive. For example, if you miss:
- $20 per visit
- 20 patients per week
- 50 weeks per year
That’s $20,000 in lost revenue annually just with one small mistake.
Now imagine multiple underbilling issues happening at once. Instead of wasting this money, it can be used for:
- Hiring staff
- Expanding services
- Better equipment
- Marketing your clinic
- Paying yourself what you actually deserve
Why Acupuncture Billing Is More Complex Than It Looks
Acupuncture medical billing is tricky due to alternative medicine and traditional insurance billing. Coverage varies widely by:
- Insurance company
- State regulations
- Employer plans
- Medical necessity criteria
Some payers require:
- Specific diagnoses
- Pre-authorizations
- Limits on visits
- Strict time documentation
These factors do not affect but only if everything is billed correctly. To make it accurate, you need specialized acupuncture medical billing expertise to never miss any opportunity.
How Professional Acupuncture Billing Services Fix Underbilling
If you want your billing to be accurate with smooth revenue cycle management, you need a specialized acupuncture billing partner that understands the needs of your practice and works to help you grow. You never need to find an acupuncture medical billing company when M&M Claims Care is here for you. Let’s show you how we make our work up-to-date and efficient, so you can better decide whom to outsource your acupuncture billing to.
Accurate Code Selection Every Time
Experienced billers know:
- When to use 97810 vs 97813
- How to apply add-on codes properly
- Which modifiers are needed and when
- How to stay compliant without underbilling
Proper Time Tracking and Unit Billing
M&M Claims Care ensures:
- Time is documented correctly
- Units are billed accurately
- No services are left unclaimed
- Billing matches payer guidelines
Strong Documentation Support
Underbilling often starts with documentation issues. That’s why our professional billing team helps acupuncture clinics:
- Improve SOAP notes
- Align diagnoses with treatments
- Clearly show medical necessity
- Reduce downcoding and denials
Insurance Verification That Protects Revenue
At M&M Claims Care, we understand the importance of insurance verification for the revenue. With accurate eligibility and benefits verification:
- Coverage is confirmed before treatment
- Visit limits are tracked
- Authorizations aren’t missed
- Patients are billed correctly
Only this step can prevent massive revenue leakage.
Denial Prevention (Not Just Denial Management)
Instead of reacting to denials, M&M Claims Care focuses on preventing them in the first place. That means:
- Cleaner claims
- Faster reimbursements
- Fewer payment delays
- Less guesswork for providers
Signs Your Acupuncture Clinic Needs a Billing Partner
Still, if you are confused and don’t know what to do next? Here are some signs that will indicate your practice is underbilling and needs specialized acupuncture medical billing services.
- Your reimbursements feel lower than expected
- You rarely bill add-on units
- You avoid certain CPT codes out of fear
- Denials happen even when services were provided
- You don’t fully understand payer rules
- Billing feels stressful or confusing
Why Clinics Choose M&M Claims Care for Acupuncture Billing
At M&M Claims Care, acupuncture billing isn’t treated like an afterthought. It’s handled with precision, compliance, and a deep understanding of how acupuncture services are reimbursed. Clinics partner with M&M Claims Care for acupuncture medical billing services because they want:
- Higher, more accurate reimbursements
- Fewer billing headaches
- Less time wasted on claims follow-ups
- Better financial visibility
- Peace of mind knowing nothing is missed
Our goal is not to provide you with aggressive billing but accurate billing where the real growth happens.
