Question: Are there any rate increases for acupuncture services this year? I'm not sure how I should be adjusting my fees in 2022 or if I should at all.
Fees and allowed rates are determined by many factors, and while PPO and HMO plans often maintain their same contract rates year to year, the rates for non-contracted plans have an increase in value for acupuncture.
There is really good news for acupuncture providers, as the base value for acupuncture in 2022 has been substantially increased and should meet or exceed the rate of inflation. This increase is due to an update in the relative value of acupuncture 97810-97814.
Each service depends on its relative value unit (RVU), which is the rank on a common scale for each CPT code. This RVU creates a value for each CPT code based on the practitioner's work, the expenses of the practitioner's practice, and professional liability insurance. Fees are ultimately determined by their RVUs.
The relative value of acupuncture in 2022 has seen a significant increase, which will certainly increase reimbursement for acupuncture with some plans. For example, Medicare rates will increase due to this, as will VA reimbursement that utilizes Medicare rates. These updated values will affect any fee schedule that utilizes RVU (essentially all), which means for many states, personal-injury and workers' compensation fee schedules will also see an increase.
Understanding RVUs
To provide some insight as to how RVUs are used, there is a multiplier of a dollar value to code to determine a fee for a particular service. For example, Medicare has a dollar value conversion that is used as a multiplier; all codes and fees can be determined by taking the RVU and multiplying by that dollar amount. For Medicare in 2022, that multiplier is $34.89 (note there are geographic variances that may be higher in some regions). The RVU is multiplied by the conversion – that is the fee for that service.
For instance, in Texas, the workers' compensation fee schedule uses a conversion of $61.17; in Michigan, $47.66 (although Michigan also uses a fee schedule for personal injury that is 200 percent of Medicare rates), Utah $52, Maryland $47.12, Minnesota $58.68, and California 125 percent of Medicare rates. Therefore, you take these conversion factors and multiply them by the RVU of any code to determine its fee.
The above are just examples and are not the only states that use this formula. All fee schedules will in part use RVU to determine fees and allowances. To see the increase, one only need to look at the 2021 vs. 2022 RVUs for acupuncture. In 2021, the RVU for acupuncture was as follows:
2021
- 97810: 1.06
- 97811: 0.80
- 97813: 1.21
- 97814: 1.00
2022
- 97810: 1.16
- 97811: 0.87
- 97813: 1.36
- 97814: 1.12
This represents a substantial increase; about 6-9 percent in dollar values. Using the Texas conversion, for example, means a rate for 2022 of $70.96 compared to $64.84 for 2021.
Note that the rates for Medicare and VA have increased nationally. For example, in Los Angeles County in 2022, the Medicare fee is $42.67 for 97810, whereas in 2021 it was $40.47. This ratio increase holds for all regions across the country.
This change will certainly affect all plans that use RVUs, but may also have some effect on plans that are managed care. However, you must verify with those plans you are a member of to determine any changes to those rates. These rates should be easily disclosed to you as a member provider.
Interestingly, acupuncture has the largest jump in RVU compared to other CPT codes, for which RVU values were essentially flat. Most providers (medical, chiropractic and physical medicine) are actually seeing a decrease, as the Medicare conversion rate is slightly reduced in 2022. But with the RVU increase for acupuncture, even with a reduced conversion it still has a higher-paid rate.
Recommendations
I suggest adjusting your fees accordingly by using the RVU as a method to assign a fee. For instance, if your first set of acupuncture is $75, you would take $75 and divide by its RVU of 1.16, which is $64.66. Then take $64.66 and multiply by another code RVU value of that service based on a $75 rate for acupuncture.
In this case, for 97811, the fee would be $64.66 multiplied by 0.87 and the price would be $56.25. For 97813, it would be $87.94 and for 97814, $72.42.
This formula may be used for any other CPT code to ascertain a relative value for all CPT codes based on your rate for 97810. RVU values in 2022 are as follows for these common codes:
- 99203: 3.29
- 99213: 2.66
- 97026: 0.19
- 97124: 0.88
- 97110: 0.87
These RVU values are essentially flat, but the changes in RVU for acupuncture mean an increase in reimbursement. It is wise always to bill at your regular rate to assure you are be paid at the highest allowed value. If a carrier is willing to pay $75 and you bill only $60, you will get $60. The insurance carrier is certainly not going to inform you they would pay $75, which is why you need to review your fees immediately to assure you have the right values. This could mean what you bill for (and are reimbursed for) some codes may be raised – or lowered – once you have an understanding of RVU.
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