Dry Needling: CPT Codes, Practitioner Concerns, and More

The history of dry needling can be dated back to at least the 1940s, when the term was coined by Dr. Janet Travell. The practice of dry needling has evolved since that time, spawning multiple generations of improvements based on research and various clinical applications.

In today’s healthcare landscape, dry needling is often used as part of a multi-model treatment plan by physical therapists, physicians, and other specialists to help remedy and manage a wide range of patient conditions.

Let this article be a useful tool to learn more about dry needling, how it can fit into your practice, and what CPT codes are applicable for insurance purposes.

Dry Needling Fundamentals

What Is Dry Needling?

Dry needling is a technique that involves inserting thin needles into the skin and muscle to target areas of tension and pain called trigger points. These trigger points are often associated with muscle tightness, pain, and limited range of motion.  

The needles used in dry needling are similar to those used in acupuncture, but the technique and the intended effects are different. Dry needling aims to release muscle tension, improve blood flow, and reduce pain by stimulating the release of endorphins and other neurotransmitters. Acupuncture aims to stimulate the central nervous system to promote healing and well-being. 

How Is Dry Needling Different from Acupuncture?

Dry needling and acupuncture are two distinct therapies that involve the insertion of thin needles into the body. However, they differ significantly in their underlying principles, techniques, and therapeutic goals.  

Dry Needling

• Focus: Targets myofascial trigger points, which are irritable spots within taut bands of muscle.  
• Mechanism: Aims to release muscle tension, improve blood flow, and reduce pain by stimulating the release of endorphins and other neurotransmitters.  
• Needle placement: Needles are inserted into specific trigger points based on anatomical landmarks and the patient’s presenting symptoms.  
• Practitioners: Typically performed by physical therapists, chiropractors, and medical doctors who have received specialized training in dry needling.  

Acupuncture

• Focus: Based on the principles of traditional Chinese medicine, acupuncture aims to balance the flow of qi (life energy) through meridians (energy channels) in the body.  
• Mechanism: Stimulates the body’s natural healing processes by influencing the nervous system and promoting the release of endorphins.  
• Needle placement: Needles are inserted into specific acupuncture points located along meridians, which are believed to correspond to internal organs and systems.  
• Practitioners: Typically performed by licensed acupuncturists who have completed specialized training in acupuncture.

What Are the Benefits for Patients?

Dry needling can offer several potential benefits for patients with musculoskeletal pain, including:  

• Pain relief. By stimulating the release of endorphins and other neurotransmitters, dry needling can help reduce pain perception to provide immediate relief. It can also help to reduce referred pain, which is pain that is felt in a different location than the source of the problem.  
• Improved range of motion. Dry needling can help release tight muscles and improve flexibility, allowing for greater range of motion and reduced stiffness. This can be particularly beneficial for conditions such as muscle strains, tendinitis, and arthritis.
• Faster healing. Dry needling can stimulate the body’s natural healing process by increasing blood flow to the injured area. This increased blood flow can help deliver oxygen and nutrients to the damaged tissues, promoting faster healing and tissue repair.
• Reduced muscle tension. Dry needling can directly target and release trigger points, which are areas of muscle tension that cause pain and discomfort. This can help to reduce muscle spasms and improve overall muscle function.
• Improved function. By addressing underlying muscle imbalances and restoring proper muscle function, dry needling can help to improve overall physical performance and daily activities. This can be particularly beneficial for athletes and individuals who participate in physically demanding activities.

What Are the Side Effects?

While dry needling is generally safe when performed by a qualified healthcare professional, there are some potential risks and side effects to be aware of, including:

• Soreness. Some people may experience mild soreness or discomfort at the needle insertion site, which typically resolves within a few hours or days.
• Bleeding or bruising. Minor bleeding or bruising may occur at the needle puncture site, but this is usually minimal and resolves quickly.
• Muscle soreness. Some individuals may experience increased muscle soreness for a short period after the treatment session.

In rare cases, patients may experience more serious side effects such as:

• Pneumothorax. In very rare cases, there is a risk of puncturing the lung (pneumothorax) if the needle is inserted too deep into the upper chest or neck region.
• Nerve injury. While extremely rare, there is a slight risk of nerve injury if the needle is inserted incorrectly.

To minimize these risks, it’s crucial to undergo specialized training in dry needling.  This means you will be able to assess the patient’s individual needs and perform the procedure safely and effectively.

How Does Dry Needling Work?

Dry needling works through several mechanisms to alleviate pain and improve muscle function, including:

• Local twitch response. When a needle is inserted into a trigger point, it can elicit a small, involuntary contraction of the muscle fibers. This can help release muscle tension and improve blood flow.
• Release of endorphins. The prick sensation from the needle can stimulate the release of endorphins, the body’s natural pain relievers. This can help reduce pain perception and promote relaxation.
• Reduced muscle tension. Dry needling can directly target and release trigger points, which are areas of muscle tension that can cause pain and discomfort. This can help reduce muscle spasms and improve overall muscle function.
• Improved blood flow. Dry needling can increase blood flow to the targeted area, which can help deliver oxygen and nutrients to the tissues and promote healing.
• Neurophysiological effects. Dry needling can also have neurophysiological effects, such as modulating pain signals and activating the body’s natural healing mechanisms.

Dry Needling: CPT Codes & Other Practitioner Concerns

Do Practitioners Need to Be Specially Licensed to Perform Dry Needling?

Yes, you typically need to be specially licensed or certified to perform dry needling. This includes practitioners such as:

• Physical therapists. In many states, physical therapists are legally authorized to perform dry needling. They often integrate dry needling into a comprehensive treatment plan that includes other modalities like exercise, manual therapy, and education.
• Acupuncturists. Acupuncturists are trained in the use of needles for therapeutic purposes and may offer dry needling as part of their practice.
• Chiropractors. Some chiropractors are trained in dry needling and may incorporate it into their treatment plans for musculoskeletal pain.
• Medical doctors. In some cases, medical doctors may perform dry needling, particularly in pain management clinics or sports medicine settings.

It’s important to note that the specific regulations regarding who can perform dry needling vary from state to state. Therefore, it’s crucial to check the regulations in your specific area to ensure that you are legally authorized to provide this service.

What Do Practitioners Need to Know to Perform Dry Needling?

To effectively perform dry needling, practitioners must possess a comprehensive understanding of some key areas.

• Anatomy and physiology: A deep understanding of musculoskeletal anatomy, including the nervous system, is paramount. This knowledge enables practitioners to accurately identify and target trigger points.
• Pathology: A strong grasp of the underlying causes of musculoskeletal pain, such as muscle strain, injury, or overuse, is essential for tailoring appropriate treatment plans.
• Trigger point theory: Practitioners must be proficient in identifying and treating trigger points, which are irritable spots within taut bands of muscle.
• Dry needling technique: This includes mastering needle insertion techniques, including the depth and angle, to optimize therapeutic benefits while minimizing discomfort.
• Patient assessment: Thoroughly assessing a patient’s medical history, current symptoms, and pain patterns is crucial to determine the suitability of dry needling and develop an individualized treatment plan.
• Contraindications and precautions: Practitioners must be well-versed in the contraindications and precautions associated with dry needling, such as bleeding disorders, pregnancy, and certain medical conditions.
• Pain management: Effective communication and pain management techniques are essential to ensure patient comfort throughout the procedure.
• Post-treatment care: Providing clear instructions for post-treatment care, including recommended exercises or stretches, is crucial for optimal outcomes.

Is Dry Needling Covered by Insurance?

Whether dry needling is covered by insurance depends on several factors.

• Patient’s insurance plan: Different insurance plans have varying levels of coverage for physical therapy and other medical services.
• State regulations: Some states have specific regulations regarding the coverage of dry needling by insurance providers.
• Specialty: The type of healthcare provider (e.g., physical therapist, chiropractor, medical doctor, etc.) and their credentials may influence insurance coverage.

To determine if the patient’s insurance plan covers dry needling, you should contact the insurance company directly. They can provide you with specific information about the patient’s coverage and any necessary prior authorization requirements.

If the insurance plan doesn’t cover dry needling, you may consider negotiating with your patient or explore other payment options. For example, you may offer flexible payment plans or discounts for cash payments.

What Are the Best CPT Codes to Use?

The CPT codes for dry needling are:

• 20560: Needle insertion(s) without injection; 1 or 2 muscle(s)  
• 20561: Needle insertion(s) without injection; 3 or more muscles  

These codes were introduced in 2020 and are specifically designed for dry needling procedures. They are untimed codes, meaning the reimbursement is based on the number of muscles treated, rather than the time spent on the procedure.  

It’s important to note that while these codes exist, their coverage by insurance providers may vary. Check with the patient’s insurance provider to determine whether the provider covers dry needling and which codes to use for billing purposes.

Dry Needling Is an Asset for Many Healthcare Practitioners

Dry needling has emerged as a valuable tool for physical therapists and other specialists in managing musculoskeletal pain. By targeting trigger points and stimulating the body’s natural healing processes, dry needling can provide significant relief and improve functional outcomes.

Understanding the benefits, risks, limitations, and CPT codes of this technique can help you effectively incorporate dry needling into your practice and provide optimal care for your patients.