When submitting manipulation claims, doctors of chiropractic must use an Acute Treatment (AT) modifier. To identify services that are active/corrective treatment of an acute or chronic subluxation. The AT modifier, when used appropriately, should indicate an expectation of functional improvement.
Can a chiropractor bill Medicare for services that are not covered?
Chiropractic services. when provided by a chiropractor or other qualified provider. Medicare doesn't cover other services or tests ordered by a chiropractor, including X-rays, massage therapy, and acupuncture. If you think your chiropractor is billing Medicare for chiropractic services that aren't covered, you can report suspected Medicare fraud.
Why choose Medical billers and coders for chiropractic billing?
Medical Billers and Coders is a renowned medical billing service provider that can effectively handle all your chiropractic medical billing and Chiropractic Credentialing Service needs and claim settlements. For more information call us at +1-888-357-3226.
What is the at modifier for chiropractic care?
For Medicare purposes, a chiropractor must place an AT modifier on a claim when providing active/corrective treatment to treat acute or chronic subluxation. However, the presence of the AT modifier may not in all instances indicate that the service is reasonable and necessary.
Who is responsible for paying for chiropractic services?
Access the below chiropractic services related information from this page. A Beneficiary is responsibility for these services. A provider may bill patient without billing Medicare.
What modifiers are used for chiropractic billing?
Modifiers in Chiropractic Medical Billing:Modifier 25. Modifier 25 is utilized to show that this is an important, independently recognizable evaluation and management (E/M) service by the same physician on the same day. ... GA Modifier. ... GY Modifier. ... Modifier 59. ... X-set Modifiers. ... The Active Treatment (AT) Modifier.
How do I bill chiropractic to Medicare?
Diagnosis Code Description Medicare Covered Chiropractic Services If the CPT code is 98940, 98941, or 98942 and is billed with one of the following primary diagnosis codes and with modifier AT, then the chiropractic service is covered.
What is a 21 modifier used for?
CPT Modifier 21 is used when the face-to-face service provided is prolonged or otherwise greater than usually required for the highest level of evaluation and management (E&M) service within a given category.
What CPT codes are covered by Medicare for chiropractic?
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 use GP modifier?
GP is the most appropriate for chiropractic claims, as it aligns with the therapy provider “physical therapy”.
Does 98943 need a modifier?
Simply code it as 98943, no modifiers necessary. Make sure that you have an appropriate diagnosis code that reflects the extremity problem.
What is modifier 29 used for?
What Is A 29 Modifier?: Global procedures, those procedures where one provider is responsible for both the professional and technical component. Note: Modifier 29 has been deleted. If a provider is billing for a global service, no modifier is necessary.
What is modifier 23 used for?
Modifier 23 is used only with general or monitored anesthesia codes (CPT codes 00100- 01999). Modifier 23 is added after the primary anesthesia modifier which identifies whether the service was personally performed, medically directed or medically supervised (Modifiers AA, AD, QK, QS, QX, QY or QZ).
What is modifier 22 used for?
Modifier 22 is used for increased procedural services and demonstrates when a physician has gone above and beyond the typical framework of a particular procedure.
What modifier is billed with 97110?
CQ modifierThe CQ modifier does apply to 97110 because the PTA furnished all minutes of that service independently.
Does G0283 need modifier?
Medicare does need the modifier GP appended to G0283, just like the other therapy chgs require mod GP.
How do you code chiropractic services?
The most commonly billed chiropractic CPT codes are CPT Code 98940 Chiropractic manipulative treatment (CMT); Spinal, 1-2 regions, CPT Code 98941 Chiropractic manipulative treatment (CMT); Spinal, 3-4 regions, and CPT Code 98942 Chiropractic manipulative treatment (CMT); Spinal, 5 regions.
Can You Tell Me A Little More About Your Company?
We are a San Francisco based company that provides an end-to-end platform for wellness providers like chiropractors. We are bringing a Silicon Vall...
Can You Please Explain The Differences Between Your Monthly Plans?
We have 3 different plans to help with your chiropractic practice management. All 3 plans provide basic Chiropractic EHR features including: Online...
Do I Have To Sign A Contract?
Yes, our pricing model is based on an annual contract. Let us explain why. Our onboarding process focuses on a hassle free migration from your exis...
What Separates zHealthEHR From Other Chiropractic Software Vendors?
Great question! Below are some of our key features that will make you chose zHealthEHR over other vendors. A 100% cloud-based Chiropractic EHR Soft...
Why Do You Have 3 Different Plans For Chiropractic Practice Management Software? Isn't it confusing?
We at zHealthEHR do not nickel and dime our customers. We grow along with your practice and want to provide flexibility by offering multiple choice...
Do You Charge More For Additional Users?
Any number of your front desk staff, office managers, or billing personnel can access a single subscription of zHealthEHR. We only charge per chiro...
Do You Provide Managed Billing Services?
Yes! We do provide Managed Billing Services. This includes the following: Demographic entry Charge entry, Claim Submission, Filing Coding Payment p...
How Much Does zHealthEHR Managed Billing Services Cost?
zHealthEHR charges 5% of the total (gross) amount collected from ALL insurance companies and ALL patients (excluding co-pay) as a result of the bil...
Can I Switch Plans In The Middle Of A Contract If I Decide To Upgrade Later?
We at zHealthEHR are always on your team. You can upgrade your plan at any time to utilize additional features that boost your practice.
Do You Charge Extra For Software Updates And Data Storage?
Software updates and data storage are free and secure. These items are included in your subscription plan. Updates are installed automatically with...
Can you claim pain without providing further information?
You must be able to describe and document the pain specifically with information about intensity, location, and quality. Simply noting “pain” in the documentation without providing further information isn’t acceptable. Diagnosis: The claim will only be covered if the primary diagnosis is subluxation.
Is Medicare a part of chiropractic?
For many chiropractors, Medicare patients are an important part of the practice. Getting Medicare billing right takes some care and consistency. Here are some guidelines to create your Medicare chiropractic billing guide:
Does Medicare cover chiropractic care?
Medicare does cover chiropractic care, but the program is very specific about how to establish medical necessity and demonstrate that your diagnosis fits your patient’s needs. If you don’t follow these rules, your claim may be denied or you could even risk accusations of attempted fraud.
When do chiropractors have to use the AT modifier?
For Medicare purposes, a chiropractor must place an AT modifier on a claim when providing active/corrective treatment to treat acute or chronic subluxation. However, the presence of the AT modifier may not in all instances indicate that the service is reasonable and necessary.
What is the modifier for ambulance services?
For ambulance services modifiers, single alpha characters with distinct definitions are paired to form a two-character modifier. The first character indicates the origination of the patient (e.g., patient’s home, physician office, etc.), and the second character indicates the destination of the patient (e.g., hospital, skilled nursing facility, etc.). When ambulance services are reported, the name of the hospital or facility should be included on the claim. If reporting the scene of an accident or acute event (character S) as the origin of the patient, a written description of the actual location of the scene or event must be included
What is AT modifier?
The Active Treatment (AT) modifier was developed to clearly define the difference between active treatment and maintenance treatment. Medicare pays only for active/corrective treatment to correct acute or chronic subluxation. Medicare does not pay for maintenance therapy. Claims should include a primary diagnosis of subluxation ...
When does CPT 98940 need to be included?
The policy requires the following: 1. Every chiropractic claim for CPT 98940/98941/98942, with a date of service on or after October. 1, 2004, should include the AT modifier if active/corrective treatment is being performed; and. 2. The AT modifier should not be used if maintenance therapy is being performed.
What is an acute subluxation?
1. Acute subluxation: A patient’s condition is considered acute when the patient is being treated for a new injury (identified by X-ray or physical examination). the result of chiropractic manipulation is expected to be an improvement in, or arrest of progression of, the patient’s condition. 2.
When do you need to use the AT modifier?
You must place the AT modifier on a claim when providing active/corrective treatment to treat acute or chronic subluxation. However, the presence of the AT modifier may not in all instances indicate that the service is reasonable and necessary.
Does Medicare pay for subluxation?
Medicare does not pay for maintenance therapy. Claims should include a primary diagnosis of subluxation and a secondary diagnosis that reflects the patient’s neuromusculoskeletal condition. The patient’s medical record should support the services you are billing.
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, 1862 (a) (1) (A). Allows coverage and payment for only those services that are considered to be medically reasonable and necessary. Title XVIII of the Social Security Act, 1833 (e). Prohibits Medicare payment for any claim, which lacks the necessary information to process the claim. CMS Manual System, Pub.
Article Guidance
As Noridian has recently retired the Chiropractic Services LCD, this article is offered to help guide in the billing, coding and documentation of chiropractic services, as supplementary to the provisions of the Medicare Benefit Policy Manual, Chapter 15, Section 30.5, and the Medicare Claims Processing Manual, Chapter 12, Section 220.
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.
Is Noridian Medicare copyrighted?
Some of the Provider information contained on the Noridian Medicare web site is copyrighted by the American Medical Association, the American Dental Association, and/or the American Hospital Association. This includes items such as CPT codes, CDT codes, ICD-10 and other UB-04 codes.
Does Medicare cover chiropractic care?
Medicare coverage of chiropractic service is specifically limited to treatment by means of manual manipulation of the spine to correct a subluxation (that is, by use of the hands). Navigation.
What is a 59 modifier?
Modifier 59 is utilized to show an important, separately recognizable non-E/M service by the same physician on the same day. Manual Therapy Techniques (97140) used by chiropractors is a common example of a non-E/M service. This comprises manipulation/mobilization and manual lymphatic drainage and manual traction-one area or more, every 15 minutes. As this coding (97140) involves modification, it can be updated with a 59-modifier if it is carried out on the same day as a change (CMT).
What is modifier 25?
Modifier 25 is utilized to show that this is an important, independently recognizable evaluation and management (E/M) service by the same physician on the same day. Modification of the E/M doesn’t assure you the reimbursement. There are insurance companies that won’t cover CMT and E/M on the same day. On the other hand, some will consider paying for a new patient (99201-99205) not for an old patient (99211-99215). Modifier 25 is only applicable to E/M services.
What is CMT in chiropractic?
According to the American Medical Association (AMA), chiropractic manipulative treatment (CMT) (98940-98943) is a type of manual service to influence neurophysiological and joint function.
Is modifier used improperly?
According to the Explanation of Benefits (EOBs), the modifiers were utilized more than average or used improperly. In December 2017, the Illinois Chiropractic Society (ICS) announced that the cases they studied, the modifiers, and procedure codes were billed rightly as per the information of claims, but because of a code-editing feature introduced ...
Does BCBS deny chiropractic claims?
As per the recent study, it has been noticed that Blue Cross and Blue Shield (BCBS) given denials to chiropractic practices for the claims billed with modifiers. Companies that offer medical billing services identified that the majority of the claims were denied owing to the requirement of modifiers 25 and 59. According to the Explanation of Benefits (EOBs), the modifiers were utilized more than average or used improperly. In December 2017, the Illinois Chiropractic Society (ICS) announced that the cases they studied, the modifiers, and procedure codes were billed rightly as per the information of claims, but because of a code-editing feature introduced by BCBS claims were denied. This incident has pointed to the importance of the usage of modifiers for Chiropractic Medical Billing. Proper utilization of modifiers can escalate reimbursement. If codes are billed without modifiers when it is required, the carrier will deny the claim with justification on the EOB of clubbing with another service.