Acupuncture for Veterans – A Challenge Worthy of the Battle
— Candace B Warner MD, FAAMA, AAMA Board of Directors
Working with VA patients is incredibly rewarding and frustrating at the same time. Veterans really need medical acupuncturists who can marry Eastern and Western medicine. Since 2018, the administration of the VA Community Care Network (VACCN) — which was created to provide veterans with rapid and diverse medical care and to reduce appointment waiting times — has been split into two regions. TriWest manages the West and Optum the East. I have collaborated with both companies and their policies and procedures are evolving constantly.
To work for the VA, the first step is credentialling. I originally joined the TriWest network with no difficulties. Louisiana was moved to the Eastern region, and to Optum, in 2018. Optum readily contracts with LAcs but not MDs. Physicians must request credentialing through the UHC network instead. UHC is the medical arm and Optum represents the physical health arm. Optum questioned the validity of post graduate physician training programs for MDs versus the various Oriental colleges. I had to push through upper administration and the UHC provider network to even begin the process. There are still significant differences in policies and payments between the two administrators.
The fee schedule for the VA initially was full pay, but that changed in October of 2020 when they adopted the Medicare fee schedule. As a reminder, Medicare only covers SIMPLE low back pain. Ten to 20 visits are covered in one calendar year. A KX modifier is required halfway through. Moreover, since Medicare counts one visit as any use of procedure code 97813 or 97814, most visits consume “two treatments” unless one only charges for 15 minutes. Anyone with previous surgery, a radiculopathy or other pain areas (like neck pain or migraine headaches) is not covered.
The VA does cover ALL pain problems, but it still uses the chronic low back pain fee schedule. These complex patients require more time and effort than what is allowed. The VA does cover a set number of visits, usually 12 over 60 days or eight over three to six months. Ninety-five percent of my VA patients have complex histories, failed surgeries, other injuries, and PTSD. The acupuncture procedure codes inherently include six minutes for evaluation, which is hardly enough time. An office visit is only applicable for 25 percent of their visits. Treating doctors assume all liability and are self-insured.
Code 97813 bills out at $44.52 and 97814 bills out at $73.68 for the maximum billable two units. If additional units are charged, the claim is denied outright. Other modalities, like cupping, are covered for $11.51 a visit. Neither laser therapy nor massage are covered. I still use all the modalities available, and time required to treat my veterans.
Disability in the military is based on other veterans, not the general population. Benefits are assigned after service ends. Many veterans struggle to get what they need. VA doctors do not prescribe pain medication as they did in the past. Many veterans have been medicated for years and are quite desperate for pain relief. As medical acupuncturists, we can provide that relief and have influence in their lives. The VACCN is always being threatened with budget cuts because of the VA labor unions. We cannot allow the bureaucrats to deny adequate acupuncture therapy to these patients. It is important that our Academy supports this valuable program.