How To Use Medicare Modifiers for Chiropractic Claims

So you're a chiropractor, huh? Then you must have run into some frustration when it comes to asking Medicare to settle chiropractic services that Medicare has deemed insufficiently filed. Why, even your medical biller is at wit's end trying to figure out which codes and such to use to support your claim! Maybe it's in the modifiers? Have you tried to check if this is the case?

Well, it's time to find out!

  • Do your research. You need to consult chiropractic or CPT books dealing with codes specifically used for claiming payments or fees from Medicare and other health insurance providers.
  • Find out what Medicare covers specifically. The only thing that Medicare reimburses is an adjustment of a patient's spine.Similar terms for it is subluxation, manipulation, manipulative therapy, and CMT. If this is exactly how you corrected the patient's problem with his spine, ask your medical biller to file the appropriate codes which in this case are as follows: 98940/41/42. Reads almost like a Beverly Hills zip code, right?
  • Record the situation accurately. If you performed a particularly corrective treatment needed to address an acute or lingering spinal maladjustment, this is what is called a chronic subluxation in medical terms (which you must know by now). You or your medical biller must now add the modifier letters AT parallel to the CPT codes mentioned above. These should be added to the modifier section in the Medicare claimant form or the HCFA 1500 under entry 24D (see Box number as provide in the same form).
  • Make room for correction. That is in the event of a refusal from Medicare to settle your claim that has been filed on a specific date with your patient's signature on the attached ABN form. ABN means Advanced Beneficiary Notice that often accompanies the paperwork submitted to Medicare. Anyway, if this happens, adjust the entry by appending the modifier GA parallel to the correct CPT code. This is done on the same HCFA 1500 form as well as on the Medicare form provided. By the way, use the same box for such - Box 24D. If you mistakenly overlooked the ABN form or failed to have a patient sign this, add the modifier -GZ to state this as the case.
  • Clearly state when another service was required. For example, for you to find out exactly what is wrong with your patient's spine, you first have to order an x-ray or any other means to find out your patient's exact condition prior to treatment. That is good and ideal but this is not covered by Medicare so as such, another modifier is needed to inform Medicare that this service is not within their list of reimbursable services. This case will require you to file a -GY modifier as well as the parallel CPT code to properly address this particular situation.
  • Expect multiple modifiers to add up. This is one of the travesties of filing a Medicare or HCFA 1500 form because the codes and CPTs have to add up once they are submitted for review and approval. Thank your lucky stars you have your medical biller to walk you through the maze of codes and CPTs.

It will take some sifting through the codes and CPTs to make it right but you will get around the intricacies of Medicare early enough to finally plug the loopholes so that you can stake your claim according to the law.


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