Dry Needling Physical Therapy: A Clinician's Guide for Billing Success

The technique of dry needling has become increasingly popular among physical therapists. According to a recent study, in 2020 alone, 55% of American PTs offered the service in their practice. In addition, the procedure is known for releasing muscle tension and alleviating pain. Finally, a reason not to be scared of needles! 

If you’re a physical therapist in a private clinic, providing modern treatments (like dry needling) with more traditional rehabilitation plans can make your practice lucrative. But while dry needling physical therapy is super effective in reducing pain naturally, it’s a controversial form of therapy due to the varying regulations, the qualifications of practitioners, and potential safety risks. 

However, no one can deny that dry needle therapy is in high demand with patients, and offering the service can be profitable for your clinic.

So how can you charge for dry needling physical therapy services confidently? 

Stick with these points for billing success:

• Stay compliant with state laws
• Checking the patient's insurance coverage 
• Become familiar with primary payment methods 

1. Be Mindful of State Restrictions Regarding Dry Needling in a PT Practice

Before getting to the bills, we need to review if you can even offer the service in your clinic.

Remember when you first applied as a PT to practice in a particular state? You had to meet that state’s requirements and regulations to obtain your license. And, if you’re a PT who has moved to another part of the country, you know the process begins all over again, as qualifications vary from state to state. 

Dry needling state laws follow a similar concept. It’s up to each state to decide whether a dry needling PT can practice this technique or not.

What states allow, prohibit, or don’t specify dry needling in a PT practice?

As of 2/13/22, here’s a breakdown of PT dry needling in each state: 

• 38 states & D.C. allow dry needling physical therapy (with specific requirements) - The good news, 76% of U.S. states permit this technique. However, PTs might need additional training, continuing education, or certification to perform dry needling in a specific location. 

• Five states prohibit dry needling physical therapy - The not-so-good news, 10% of U.S. states do not allow PTs to perform dry needling under any circumstances, considering it to be outside the scope of physical therapy practice.

                  State Laws and Regulations Governing Dry Needling Performed by Physical Therapists in the U.S., APT

• Seven states have no clear legislation on needling by physical therapists - The so-so news, 14% of U.S. states don’t offer any guidance or regulation addressing dry needle therapy by PTs, leaving the issue open to interpretation.

               State Laws and Regulations Governing Dry Needling Performed by Physical Therapists in the U.S., APTA

If you want more information detailing the specific laws and regulations on dry needling by PTs, contact the relevant physical therapy licensing board or regulatory agency.

2. Insurance Providers and What They Can Provide Surrounding Dry Needling in a PT Practice 

The head-scratching around integrative dry needling physical therapy doesn’t stop at state laws. There’s confusion on how to bill for this treatment, what insurance companies will cover, and if the service is included in Medicare and Medicaid. Understanding how dry needling reimbursement works can help you get paid promptly with minimal delays.

Don’t be intimidated by the codes for healthcare providers! Below, we’ve covered what you need to know concerning dry needling billing. 

How do I handle insurance and billing for dry needling?

Being well-equipped to tackle the billing complexities of dry needling can make this service in your PT clinic run as smoothly as possible. Knowing the main points of charging this technique can lessen frustration and increase profitability.

Here’s what to review: 

Know the CPT codes - In the United States, the most commonly used CPT for dry needling is the following:

• CPT code 97140 is often used with other manual therapy techniques for dry needling.
• CPT code 20552 classifies injections, single or multiple trigger points on one or two muscles. This code is used specifically for dry needling when it is performed solely to treat trigger points.

Please Note That:

• Insurance coverage may vary - One thing consistent with dry needling is that many parties interpret the service differently. As a result, insurance coverage on dry needling varies depending on the type of plan and the specific provider. For example, some insurance plans may cover the service if it is deemed medically necessary to treat a particular condition or injury. In contrast, other plans may consider it an alternative or experimental treatment and not cover the dry needling cost. 
• Be aware of Medicaid and Medicare - The Centers for Medicare and Medicaid Services (CMS) does not pay for this service if a PT performs the treatment. However, an ABN can let Medicare beneficiaries pay for the service. 

3. Get Acquainted with In-Network and Cash-Based Payment Methods for Dry Needling in a PT Practice

What should Physicians know about in-network dry needling? 

PTs in-network offering dry needling should be cautious about insurance billing. If the patient cannot prove this service is medically necessary, you cannot bill for the procedure with the insurance provider.

If the patient can prove the treatment is medically necessary, their insurance may cover some or all of the procedure. 

What might these in-network billing options look like?

Cash plus insurance: The patient partially pays during the procedure, and the rest is billed to the insurance carrier. The dry needling benefits benefits package will depend on how much the insurance carrier will pay (if any).

Self-pay plus insurance: The patient pays for the entire dry needling procedure and other PT services, which will be billed to the insurance carrier. 

What should Physicians know about cash-based PT dry needling? 

Due to a lack of insurance coverage for dry needling, patients might want to pursue a self-pay option. Therefore, preparing a treatment package for those willing to pay out of pocket is important. 

What cash-based payment plans can you offer?

Self-pay for entire PT care: Convert your patient's insurance bill to cash-based payment for all services.

Self-pay plus insurance:  As mentioned above, the patient pays for the entire dry needling procedure and other PT services, which will be billed to the insurance carrier. 

Discount rates: For patients accepting all the fees, offering them deals for multiple sessions can keep their treatment budget-friendly while providing more business to your clinic. 

Mastering Dry Needling Billing will Move the Needle in the Right Direction 

Dry needling physical therapy is a hot topic in the PT industry, and it’s clear why. Whether it’s states, insurance, or PTs, everyone has a different opinion on the technique of how it should be performed, billed, and regulated. This treatment in your practice can help patients heal their injuries more naturally and expand your clinic offerings. This technique has drawbacks (especially regarding billing and payment!), but educating yourself on the nuances of dry needling can give you the injection to tackle dry needling in your clinic. 

To learn more about PT billing for 2024, book a demo or check out our media center for more therapy tips and tricks!