What does insurance pay for CPT 97811 in Oregon?
Anonymized historical claim benchmarks for acupuncture (additional 15 min) in Oregon. Actual payment varies by payer, contract terms, modifiers, and documentation.
Updated April 1, 2026
How these numbers are calculated
Based on anonymized claims from practices over Jan 2024 – Dec 2025. Sample density is currently strong sample.
Figures reflect anonymized historical claim aggregates and are intended as directional benchmarks. Actual reimbursement varies by payer, contract terms, modifiers, place of service, and documentation.
Historical payment range
How billed, allowed, and paid amounts distribute across the sample.
| Metric | Average | Median |
|---|---|---|
| Billed amount | $65 | $65 |
| Allowed amount | $36 | $35 |
| Paid amount | $30 | $30 |
Claim performance
Anonymized historical signals on how cleanly these claims tend to get paid.
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 | Claims | Avg paid |
|---|---|---|
| Regence BlueCross BlueShield | 61 | $33 |
| Providence Health Plan | 40 | $29 |
| PacificSource | 26 | $28 |
| Kaiser Permanente | 19 | $29 |
| Moda Health | 14 | $26 |
Common reasons claims get denied
The denial reasons that most often appear in the historical sample for this code and state.
- Service not deemed medically necessary(CO-50)14 claims6% of sample
- Non-covered charge (benefit not active)(CO-96)11 claims5% of sample
- Pre-authorization absent or invalid(CO-197)7 claims3% of sample
- Claim missing information(CO-16)6 claims2% of sample
Frequently asked questions
Does insurance cover CPT 97811 in Oregon?+
Many commercial plans in Oregon cover CPT 97811 when it's medically necessary and the patient has an active acupuncture benefit. Coverage and the number of allowed visits per year vary widely by payer, employer group, and individual plan.
What's the typical insurance payment for CPT 97811 in Oregon?+
Anonymized historical claims show payments most commonly fall in the range shown above. Final payment depends on the payer's allowed amount, the patient's plan, applied modifiers, and any patient cost-share.
Why do my actual payments vary so much?+
Reimbursement varies because each payer negotiates its own allowed amounts, plans differ in deductibles and coinsurance, modifiers like 25 or 59 affect adjudication, and documentation can affect medical-necessity decisions.
Can I use these numbers to set my fees?+
These benchmarks are directional and based on past claim data — not a guarantee of future payment. They can be a useful sanity check on your fee schedule, but contracted rates with each payer remain the source of truth for what you will be paid.
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.
- 98941 · Chiropractic adjustment (3–4 regions)CPT 98941 reimbursement in California
Chiropractic benchmarks for Chiropractic adjustment (3–4 regions) in California.
- 98942 · Chiropractic adjustment (5 regions)CPT 98942 reimbursement in Texas
Chiropractic benchmarks for Chiropractic adjustment (5 regions) in Texas.
- 98940 · Chiropractic adjustment (1–2 regions)CPT 98940 reimbursement in California
Chiropractic benchmarks for Chiropractic adjustment (1–2 regions) in California.
- 97140 · Manual therapyCPT 97140 reimbursement in Washington
Physical Therapy benchmarks for Manual therapy in Washington.
Want help billing claims like these?
Soundry helps practices submit, track, and manage insurance claims — and gives you full visibility into what's been paid, what's pending, and what's denied.