How much does insurance pay for CPT 97813?
Acupuncture, one or more needles, with electrical stimulation; initial 15 minutes. Anonymized historical insurance payments by state, from claims processed through Soundry.
Quick answer
Across the 17 states with published Soundry benchmarks, the median insurance payment for CPT 97813 (acupuncture w/ e-stim, initial 15 min) ranges from $0 in Georgia to $91 in Wisconsin. Payment depends on the state, payer, and plan.
CPT 97813 insurance payments by state
Paid amounts are what insurers paid after patient cost sharing. The middle 50% shows the range between the 25th and 75th percentile.
| State | Median paid | Middle 50% paid | Median allowed | Sample |
|---|---|---|---|---|
| Arkansas | $47 | $47 – $51 | $47 | 100–249 claims |
| Colorado | $54 | $54 – $54 | $54 | fewer than 50 claims |
| Florida | $35 | $0 – $50 | $56 | 250+ claims |
| Georgia | $0 | $0 – $38 | $38 | 50–99 claims |
| Illinois | $39 | $22 – $59 | $59 | 100–249 claims |
| Louisiana | $51 | $47 – $51 | $51 | 50–99 claims |
| Maryland | $24 | $22 – $27 | $37 | fewer than 50 claims |
| Massachusetts | $50 | $3 – $52 | $52 | 50–99 claims |
| Nebraska | $20 | $11 – $128 | $40 | fewer than 50 claims |
| New Jersey | $44 | $44 – $44 | $44 | fewer than 50 claims |
| New York | $15 | $15 – $66 | $40 | 250+ claims |
| Oregon | $46 | $31 – $56 | $51 | 250+ claims |
| Pennsylvania | $43 | $26 – $43 | $43 | fewer than 50 claims |
| South Dakota | $40 | $40 – $40 | $40 | fewer than 50 claims |
| Texas | $51 | $47 – $51 | $51 | 250+ claims |
| Virginia | $0 | $0 – $16 | $31 | fewer than 50 claims |
| Wisconsin | $91 | $0 – $99 | $124 | fewer than 50 claims |
How CPT 97813 is billed
Acupuncture is billed in 15-minute units of personal one-on-one contact: an initial code (97810, or 97813 with electrical stimulation) followed by add-on codes (97811 or 97814) for each additional 15 minutes. Many plans cap the number of covered visits per year.
Frequently asked questions
How much does insurance pay for CPT 97813?+
Across the 17 states with published Soundry benchmarks, the median insurance payment for CPT 97813 (acupuncture w/ e-stim, initial 15 min) ranges from $0 in Georgia to $91 in Wisconsin. Payment depends on the state, payer, and plan.
How is CPT 97813 billed?+
Acupuncture is billed in 15-minute units of personal one-on-one contact: an initial code (97810, or 97813 with electrical stimulation) followed by add-on codes (97811 or 97814) for each additional 15 minutes. Many plans cap the number of covered visits per year.
Where do these numbers come from?+
They are anonymized, aggregated insurance payments from claims processed through Soundry. A state is published only when it has enough claims from multiple practices, and individual practices, payer contracts, and claims are never shown.
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