CPT code 97813: Acupuncture2026 Medicare rate & RVUs in Utah
Report 97813 for the initial 15 minutes of one-on-one acupuncture when electrical stimulation is applied through one or more needles.
Medicare pays $54.47 for 97813 in the office in Utah (Utah). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 97813 covers
A physician or other qualified practitioner performs acupuncture by inserting needles at one or more points and applying electrical stimulation through the needles. The service is used in outpatient care, including treatment sessions for pain, in office or facility settings. The timed service requires direct, one-on-one contact with the patient; the code identifies the initial interval of that treatment.
Report 97813 once for the initial 15-minute interval when electrical stimulation is used. For additional qualifying intervals of acupuncture with electrical stimulation, report 97814. Choose the code based on the technique performed, not simply the patient’s diagnosis or the number of needles. Documentation should identify the acupuncture treatment, use of electrical stimulation, and duration of direct contact. CMS PFS valuation includes work, practice expense, and malpractice inputs; the practice-expense input differs between office and facility settings.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
97813 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | $54.47 | $32.81 |
How the 97813 rate is calculated
Each of 97813’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 97813
RVUs × geographic indexes × conversion factor
Work0.74
0.74 RVUs× 1.000 GPCI
Practice expense0.90
0.90 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
1.6900
Conversion factor
$33.4009
Medicare rate
$56.45
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 97813
97813 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 97813
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$56.45
- Non-facility (office)
- $56.45
- Facility
- $33.40
Higher because the practice carries its own overhead.
97813 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 97810Acupuncture
- Both represent the initial timed acupuncture interval. Choose 97813 when electrical stimulation is applied through the needles; choose 97810 when it is not.
- 97814Acupuncture
- 97813 represents the initial timed interval with electrical stimulation. 97814 represents each additional qualifying interval of that treatment.
- 97811Acupuncture
- 97811 represents additional acupuncture time without electrical stimulation. For additional time after 97813 when stimulation continues, use 97814.
97813 billing questions
How does 97813 differ from 97810?
Both describe the initial timed acupuncture service, but 97813 is for treatment with electrical stimulation through the needles. Use 97810 when acupuncture is performed without electrical stimulation.
When is 97814 reported with 97813?
Report 97814 for each additional qualifying 15-minute interval of acupuncture with electrical stimulation after the initial interval represented by 97813.
Can 97811 be used for additional time after 97813?
No. 97811 describes additional acupuncture time without electrical stimulation; 97814 is the additional-time code for treatment with electrical stimulation.
What documentation supports 97813?
Record that acupuncture was performed with electrical stimulation, the treatment provided, and the duration of direct one-on-one contact supporting the initial timed interval.
Does the number of needles determine whether to use 97813?
No. The distinguishing feature is electrical stimulation during the acupuncture service, not the number of needles.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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