Full Answer
Are chiropractors still confused with CPT code 97140?
Unfortunately, trouble still abounds with this code, chiropractors and their billing staff are still (sometimes) confused and audits on CPT Code 97140 have definitely increased.
Is CMT covered by Medicare 97140?
Thus, if 97140 is bundled with or into CMT, it would be a violation of Medicare law. Furthermore, the Medicare relative value units (RVU) do not include any non-spinal services for (e.g., 97140, 97112, 97124 etc.)
How do you Bill 97110 and 97140?
Count the first 30 minutes of 97110 as two full units. Compare the remaining time for 97110 (33-30 = 3 minutes) to the time spent on 97140 (7 minutes) and bill the larger, which is 97140. 18 minutes of therapeutic exercise (97110), 13 minutes of manual therapy (97140), 10 minutes of gait training (97116), 8 minutes of ultrasound (97035),
What if my payer won’t pay 97140 and 9894x on the same day?
Steer Around the Strange — if you are contracted and you discover a payer that, for example, simply won’t pay for 97140 and 9894x on the same day, then you have the opportunity to reconfigure your own procedures so that you can avoid trouble with that payer.
Can a chiropractor bill CPT code 97140?
American Medical Association (AMA) coding guidelines dictate that it is only appropriate to bill for Chiropractic Manipulative Treatment (CMT) and manual therapy (CPT code 97140) for the same patient on the same visit under certain circumstances.
Does Medicare pay for CPT 97140?
Also, Medicare NCCI edits categorized 97140 as a component of CMT, unless a modifier (e.g., -59) is used for a different region(s). However, Medicare law prohibits coverage and payment for non-CMT services. Thus, if 97140 is bundled with or into CMT, it would be a violation of Medicare law.
What chiropractic codes are covered by Medicare?
Doctors of chiropractic are limited to billing three Current Procedural Terminology (CPT) codes under Medicare: 98940 (chiropractic manipulative treatment; spinal, one to two regions), 98941 (three to four regions), and 98942 (five regions).
Can chiropractors Bill 97110?
Chiropractors in helping the mobility of muscles, joints and extremities commonly use the 97110 CPT code. The description of CPT 97110 states “therapeutic exercise” which can include any kind of exercise whether it's performed by a physical therapist, occupational therapist or a chiropractic.
Does 97140 require a modifier?
CMS states that when billing 97140 and any of its paired codes for the same session or date, modifier 59 is only appropriate if the therapist performs the two procedures in distinctly different 15-minute intervals.
Can a massage therapist Bill 97140?
The CPT codes massage therapists can use without question are: 97010 - hot and cold packs; 97124 - massage; and 97140 - manual therapy.
How many chiropractic adjustments Does Medicare pay for?
The program will cover up to 12 sessions over 90 days, with a potential eight additional sessions if symptoms are improving.
What is the Medicare allowable rate for chiropractic services?
The result is a Medicare allowable amount cut of 19.54% for chiropractic adjustments.
What CPT codes can chiropractors use?
Documentation requirements Claims submitted for Chiropractic Manipulative Treatment (CMT) CPT codes 98940, 98941, or 98942, (found in Group 1 codes under CPT/HCPCS Codes) must contain an AT modifier or they will be considered not medically necessary.
Does Medicare cover code 97110?
If an exercise is taught to a patient and performed for the purpose of restoring functional strength, range of motion, and flexibility, CPT code 97110 is the appropriate code.
Can chiropractors bill GP modifier?
GP is the most appropriate for chiropractic claims, as it aligns with the therapy provider “physical therapy”. This does not mean Medicare is paying chiropractic providers for therapy; however, GP is a necessary modifier to assure a proper denial for a secondary payer to make payment.
How much does Medicare reimburse for 97110?
Therapeutic exercise (97110) will drop by an average of 3.3%, going from $31.40 to $30.36.
What is 97140 chiropractic?
Per CPT® guidelines, 97140 describes manual therapy techniques, such as mobilization and manipulation, manual lymphatic drainage, and manual traction. Chiropractic adjustments have their own set of codes (98940-98942, or 98943 for an extremity). If you report a subluxation diagnosis code, you must perform an adjustment — especially if you are in a state where you need a nexus to the spine to bill anything other than the adjustment.#N#National Correct Coding Initiative (NCCI) claim edits bundle manual therapy (97140) to chiropractic adjustment codes (98940-98942) when performed in the same anatomic region. If the procedures are performed in separate anatomic regions, you may report them separately by appending modifier 59 to the adjustment code (97410 is the “column 2” procedure). If the claim is properly filed and supported by documentation, the insurer should pay for both procedures.#N#Example 1: The chiropractor performs chiropractic adjustment (98940 Chiropractic manipulative treatment (CMT); spinal, 1-2 regions) on the cervical region. He then performs manual therapy (97140) to the same cervical region. The patient’s diagnosis codes reflect a cervical subluxation (739.1 Nonallopathic lesions, cervical region) and muscle spasms (728.85 Spasm of muscle). The manual therapy (97140) would not be reimbursable in this scenario.#N#Example 2: The chiropractor performs chiropractic adjustment (98941 Chiropractic manipulative treatment (CMT); spinal, 3-4 regions) on the cervical and lumbar regions. He or she then performs manual therapy (97140) on the patient’s shoulder. The patient’s diagnosis codes are cervical subluxation (739.1), lumbar degenerative disc disease (722.52 Degeneration of lumbar or lumbosacral intervertebral disc), adhesive capsulitis (726.0 Adhesive capsulitis of shoulder), and muscle spasms (728.85). The diagnosis pointers link the manual therapy (97140) to the diagnosis codes adhesive capsulitis (726.0) and muscle spasms (728.85). In this scenario, the manual therapy would be separately reimbursable if reported with modifier 59 appended.#N#To best support payment and minimize audit red flags, the provider’s notes should include:
What is the adjustment code for 97410?
If the procedures are performed in separate anatomic regions, you may report them separately by appending modifier 59 to the adjustment code (97410 is the “column 2” procedure). If the claim is properly filed and supported by documentation, the insurer should pay for both procedures.
Does Aetna cover chiropractic?
Aetna has made a nationwide policy decision for chiropractic reimbursement, which states that when manual therapy (97140 Manual therapy techniques, one or more regions, each 15 minutes) is performed on the same date of service (DOS) as a chiropractic manipulative treatment (98940-98943), the manual therapy will be denied, automatically.
Does Aetna pay on 4 codes?
Just because Aetna paid on four codes, doesn’t mean they’ve paid on four modalities. To help ensure your claims are processed correctly, in addition to sending your doctor’s notes with the original claim, use diagnosis pointers.
Can an out-of-network provider bill 97140?
If you are in network, you have agreed to Aetna’s policies (through your contracts), and you’ll most likely need to write off reimbursement for 97140. In-network providers cannot bill the patient.
Does Aetna pay for more than 4 modalities?
Note that Aetna usually only allows payment for four modalities per visit. This raises a question: If you bill for five or six modalities, for instance, and Aetna only pays for four modalities, should you bother appealing 97140?#N#I suggest you don’t have to appeal because you won’t receive additional compensation, in any case. But be aware some Aetna plans will reimburse for more than four modalities. Be sure, however, that your definition of a modality is the same as Aetna’s. For example, office visits are not part of the four-modality cap. This means that when supported by medical necessity, you can render an office visit in addition to four modalities. Just because Aetna paid on four codes, doesn’t mean they’ve paid on four modalities.#N#To help ensure your claims are processed correctly, in addition to sending your doctor’s notes with the original claim, use diagnosis pointers. Most billing programs default diagnosis pointers to 1, 2, 3, etc., or now A, B, C, etc., on the new claim forms, depending on how many diagnosis codes you input. Diagnosis pointing is under-utilized in billing, especially in the chiropractic world. Using diagnosis pointers can help differentiate the region (s) adjusted/manipulated from the region (s) on which the doctor performed manual therapy (97140).#N#Additional resources: Aetna Clinical Policy Bulletin: Chiropractic Services Number: 0107
What is part B in chiropractic?
Chiropractic services. Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.
What is Medicare approved amount?
Medicare-Approved Amount. In Original Medicare, this is the amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and you’re responsible for the difference. and the Part B.
Does Medicare cover chiropractors?
When one or more of the bones of your spine move out of position. . Medicare doesn't cover other services or tests a chiropractor orders, including X-rays, massage therapy, and acupuncture.
The pesky early years of the 97140 code
One of the biggest challenges faced by doctors of chiropractic (DCs) was that the old code 97150-Myofascial Release, which many providers used for trigger-point therapy, was billed along with the CMT code for any muscle work performed in conjunction with the adjustment.
The pesky 97140 CPT Code: 2021
Some payers, such as Optum, have finally taken the guesswork out of when and how to append the -59 modifier when performing CMT along with procedure code 97140 – manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction) on one or more regions (15 minutes each).
How would you answer these questions?
Considering the increasing scrutiny and number of audits, it’s time for a self-check to make sure you have what’s necessary to properly bill both CMT and 97140 on the same visit:
Tips to avoid Code 97140 Denials
Our billing experts have received lots of inquiries over the past year regarding denials from BlueCross BlueShield (BCBS) for certain services rendered and billed. We want to assist you in dealing specifically with code 97140 and the claims edit process. But first, here’s a little background on the subject.
BCBS Claims Processing Protocol
A claims processing protocol was instituted by BCBS in November 2017, (“code-auditing enhancement” via “clinically validating modifiers”) that began denying some providers’ claims on codes that require the modifiers 25 or 59 (including XE, XS, XP, XU).
What are the criteria for CPT code 97140?
When reporting the CPT code 97140 in conjunction with CMT codes, there are six criteria that must be documented to validate the#N#service:#N#1. Manipulation was not performed to the same anatomic region or a contiguous anatomic region e.g., cervical and thoracic#N#regions are contiguous; cervical and pelvic regions are noncontiguous
What is the CPT code for massage?
AOTA requests that the reference to connective tissue massage and therapeutic massage be removed from this code, as massage is appropriately billed under CPT code 97124. To the extent that the reference was intended to include connective tissue mobilization and transverse friction massage as manual therapy techniques, AOTA would support these inclusions.
Is 97140 a CMT?
Also, Medicare NCCI edits categorized 97140 as a component of CM T, unless a modifier (e.g., -59) is used for a different region (s). However, Medicare law prohibits coverage and payment for non-CMT services. Thus, if 97140 is bundled with or into CMT, it would be a violation of Medicare law.
Is manual traction necessary for cervical radiculopathy?
Manual therapy includes the following modalities: Manual traction may be considered reasonable and necessary for cervical radiculopathy. Joint mobilization (peripheral or spinal) may be considered reasonable and necessary if restricted joint motion is present and documented.
Does Blue Cross reimburse massage?
Blue Cross will not reimburse providers for massage or manual therapy. services (97124 and 97140). Massage or manual therapy will deny. either as incidental (provider liability) or subscriber liability. Massages that are provided as preparation for a physical medicine.
What is CPT code 97140?
CPT Code 97140: Manual therapy techniques (e.g. mobilization, manipulation, manual lymphatic drainage, manual traction) one or more regions, each 15 minutes. [1] Description Code 97140 is used to report manual therapy (‘hands-on’) techniques that consist of , but are not limited to connective tissue massage, joint mobilization, manual traction, passive range of motion, soft tissue mobilization and manipulation, and therapeutic massage. Manual therapy techniques may be applied to one or more regions for 15-minute intervals. These services are not diagnosis or region specific.
What is traction in CPT 97012?
CPT 97012 Mechanical traction is described as force used to create a degree of tension of soft tissues and/or to allow for a separation between joint surfaces. The degree of traction is controlled through the amount of force (pounds) allowed, duration of time, and angle of the pull (degrees) using mechanical means. Used in describing cervical and pelvic traction that are intermittent or static (describing the length of time traction is applied), or autotraction (use of the body’s own weight to create the force). A common question is whether a roller table type of traction meets the above-noted requirements. According to the ACA’s interpretation, table type traction would normally meet the requirements of autotraction.
What is the CPT code for constant attendance?
The CPT Manual defines a modality as “any physical agent applied to produce therapeutic changes to biologic tissues; includes but not limited to thermal, acoustic, light, mechanical, or electric energy.” CPT codes within the code range of 97032-97036 are “Constant Attendance” codes that require direct (one-on-one) patient contact by the provider. These codes contain a time component (15 minutes) and time is recorded based on constant one-on-one attendance.
What is S9090 code?
• All claims for this service must be coded using S9090, with one unit of service per day.#N#• Based on the lack of scientific evidence (blinded studies, appropriate number of participants in studies already conducted, documented long-term results) S9090 will be allowed based on the 97012 allowance and unit limitation guidelines.#N#• This policy will remain in effect until such time that scientific studies performed within accepted standards are available.#N#• To ensure correct coding of this service there will be periodic audits performed at random.#N#• Those claims found to have been coded incorrectly will require appropriate refunds and patients’ credits.#N#Policy Overview
How long can a therapist bill for a supervised modality?
In the same 15-minute time period, one therapist may bill for more than one therapy service occurring in the same 15-minute time period where “supervised modalities” are defined by CPT as untimed and unattended — not requiring the presence of the therapist (CPT codes 97010 – 97028). One or more supervised modalities may be billed in the same 15-minute time period with any other CPT code, timed or untimed, requiring constant attendance or direct one-on-one patient contact. However, any actual time the therapist uses to attend one-on-one to a patient receiving a supervised modality cannot be counted for any other service provided by the therapist.
What is correct coding in Medicare?
This policy is used to promote correct coding by physicians and to ensure that it makes appropriate payments for physician services. [6] “This policy has been developed and applied by many third party payers across the country.” [7] Correct coding emphasizes that procedures should be reported with the CPT codes that most comprehensively describe the services performed e.g., 98941 is a more comprehensive code than 98940. There are procedural codes that are not to be reported together because they are mutually exclusive to each other. Mutually exclusive codes are those codes that cannot reasonably be done in the same session. An example of mutually exclusive codes germane to this policy is 97140 – Manual therapy techniques (without the -59 modifier) vs. 98940, 98941, 98942, or 98943 – Chiropractic manipulative treatment.
What is the CPT code for a therapeutic procedure?
CPT codes within the code ranges of 97110-97124, 97140, and 97530-97542 require direct (one-onone) patient contact by the provider.
General Information
CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Title XVIII of the Social Security Act, §1833 (e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
Article Guidance
The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Chiropractic Services L37387.
ICD-10-CM Codes that Support Medical Necessity
The use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in the Chiropractic Services L37387 LCD.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.