What does insurance pay for CPT 97813 in Oregon?
Anonymized historical claim benchmarks for acupuncture w/ e-stim (initial 15 min) in Oregon. Actual payment varies by payer, contract terms, modifiers, and documentation.
Updated November 8, 2026
Quick answer
In Oregon, insurers paid a median of $45 for CPT 97813 (acupuncture w/ e-stim, initial 15 min), with the middle half of payments between $35 and $56. This is based on a very large sample of anonymized claims from Nov 2025 – Nov 2026. The median allowed amount was $51.
How these numbers are calculated
Based on anonymized claims from practices over Nov 2025 – Nov 2026.
These numbers reflect anonymized historical claim patterns and are not a guarantee of future payment. Actual reimbursement varies by payer, contract terms, modifiers, and documentation.
Historical payment range
How billed, allowed, and paid amounts distribute across the sample.
| Metric | Average | Median |
|---|---|---|
| Billed amount | $100 | $100 |
| Allowed amount | $51 | $51 |
| Paid amount | $42 | $45 |
Time to payment
Days from the date of service to the insurance payment, across paid claims in this sample.
Common payers in the sample
Payers most often associated with this code in the historical data. Specific contracted rates with each payer remain the source of truth.
| Payer | Share of claims | Avg paid |
|---|---|---|
| TriWest VA CCN Region 4 | 44.6% | $51 |
| Regence BlueCross BlueShield of Oregon | 22.1% | $29 |
Frequently asked questions
What does insurance pay for CPT 97813 in Oregon?+
In Oregon, insurers paid a median of $45 for CPT 97813 (acupuncture w/ e-stim, initial 15 min), with the middle half of payments between $35 and $56. This is based on a very large sample of anonymized claims from Nov 2025 – Nov 2026. The median allowed amount was $51.
What is the difference between the allowed amount and the paid amount?+
The allowed amount is what the plan recognizes for the service under its contract or fee schedule (median $51 here). The paid amount is what the insurer actually paid after the patient's deductible, copay, or coinsurance (median $45). The difference is generally collected from the patient.
How long do insurers take to pay CPT 97813 claims in Oregon?+
For paid claims in this sample, the median time from date of service to insurance payment was 11 days.
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.
Are these numbers a guarantee of payment?+
No. They are anonymized historical benchmarks from claims processed through Soundry. Actual payment depends on the payer, plan, contract, modifiers, and documentation.
Related reimbursement pages
Explore other CPT codes and states with anonymized historical benchmarks.
- 97810 · Acupuncture (initial 15 min)CPT 97810 reimbursement in Oregon
Acupuncture benchmarks for Acupuncture (initial 15 min) in Oregon.
- 97811 · Acupuncture (additional 15 min)CPT 97811 reimbursement in Oregon
Acupuncture benchmarks for Acupuncture (additional 15 min) in Oregon.
- 97814 · Acupuncture w/ e-stim (additional 15 min)CPT 97814 reimbursement in Oregon
Acupuncture benchmarks for Acupuncture w/ e-stim (additional 15 min) in Oregon.
- 97813 · Acupuncture w/ e-stim (initial 15 min)CPT 97813 reimbursement in Texas
Acupuncture benchmarks for Acupuncture w/ e-stim (initial 15 min) in Texas.
- 97813 · Acupuncture w/ e-stim (initial 15 min)CPT 97813 reimbursement in Arkansas
Acupuncture benchmarks for Acupuncture w/ e-stim (initial 15 min) in Arkansas.
- 97813 · Acupuncture w/ e-stim (initial 15 min)CPT 97813 reimbursement in Louisiana
Acupuncture benchmarks for Acupuncture w/ e-stim (initial 15 min) in Louisiana.
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