Dry needling consent form template 2025

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Each dry needling CPT code type is differentiated by the number of muscles treated in the session. The two TPDN CPT codes are: Code 20560: Needle insertion(s) without injection; 1 or 2 muscle(s). Code 20561: Needle insertion(s) without injection; 3 or more muscle(s).
Dry Needling is a skilled intervention performed by a physical therapist that uses a thin filiform needle to the skin and stimulate underlying neural, muscular and connective tissues for the evaluation and management of neuromusculoskeletal pain and movement impairments.
The minimal requirements for documenting dry needling are in addition to and not in place of normal physical therapy notes, and include at least the following information: i. The anatomical region treated; ii. The manner in which the patient tolerated the treatment; and iii. The clinical outcome of the treatment.
The specific indication(s) for this intervention must be clearly documented and supported by the clinical notes. Patients should be informed in writing that the evidence for dry needlings effectiveness is inconclusive and the service is unproven and therefore not a covered service.
Considerations in preparing the informed consent document: Elements of consent present. Complete explanations. Lay language. Protection of confidentiality. No unproven claims of effectiveness. Device studies include a statement that the study includes an evaluation of the safety of the test article.
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No prerequisites are needed for this three-day 27-hour dry needling course; however, registrants must be a licensed PT, PTA, ATC, DC, MD, DO, DDS, NP, PA, OT, or acupuncturist in their respective state or country. DPT, DC, or MD students in their final year are also eligible to take DN-1 and DN-2.

dry needling consent form pdf