Article - Billing and Coding: Chiropractic Services (A58412)

CMS National Coverage PolicyInternet-Only Manuals (IOMs)CMS IOM Publication 100-02,Medicare Benefit Policy Manual,Chapter 15, Sections 30.5 Chiropractors Services, 240 Chiropractic Services  General, 240.1  Coverage of Chiropractic Services, 240.1.1  Manual Manipulation, 240.1.2  Subluxation May Be Demonstrated by X-Ray or Physicians Exam, 240.1.3  Necessity for treatment, 240.1.4  Location of Subluxation, and 240.1.5  Treatment ParametersCMS IOM Publication 100-04,Medicare Claims Processing Manual,Chapter 12, Section 220 Chiropractic ServicesChapter 30, Financial Liability ProtectionsSocial Security Act (Title XVIII) Standard References:Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.Article TextThis Billing and Coding Article provides billing and coding guidance for Chiropractic Services.Coding GuidanceNotice:It is not appropriate to bill Medicare for services that are not covered as if they are covered. When billing for non-covered services, use the appropriate modifier.When billing for Chiropractic services:Report the initial treatment or date of exacerbation.Specify the precise spinal location and level of subluxation.Report the date of X-ray if an X-ray is used to demonstrate subluxation.Report the level of subluxation using the appropriate ICD-10-CM code.In addition to reporting the ICD-10-CM code for the level of subluxation, report any other pertinent ICD-10-CM codes.All treatments must be categorized as acute subluxation, chronic subluxation or maintenance therapy. An exacerbation of a previous injury should be categorized into either "acute" or "chronic" (e.g., an identifiable re-injury would fall under acute).The following modifiers should be reported with CPT codes 98940, 98941, and98942 as is appropriate to each patient's situation:AT  Acute treatmentGA  Waiver of liability statement issued as required by payer policy, individual case. Authorization has been provided to notify the beneficiary of the likelihood that services rendered will be denied as not reasonable and medically necessary under Medicare guidelines.GZ  Item or service expected to be denied as not reasonable and necessaryFor Medicare purposes, the AT modifier shall now be used only when chiropractors bill for active/corrective treatment.Every chiropractic claim (those containing CPT codes 98940, 98941, or 98942) with a date of service on or after October 1, 2004 is to include the AT modifier if active/corrective treatment is being performed; orThe AT modifier should not be appended to the service if maintenance therapy is being performed. Contractors shall deny a chiropractic claim (containing CPT codes 98940, 98941, or 98942) with a date of service on or after October 1, 2004, that does not contain the AT modifier.The mere presence of the AT modifier does not indicate that the service(s) are medically necessary. Reasonable and necessary requirements as addressed in the Medicare Internet-Only Manuals must be met.Reasons for DenialExcluded from Medicare coverage is any service other than manual manipulation for the treatment of subluxation of the spine. The chiropractor is not required to bill excluded services. However, if the beneficiary requests Medicare be billed, the provider must bill services to Medicare in order to obtain a denial for secondary insurance purposes. The following are examples (not an all-inclusive list) of services excluded from Medicare coverage when performed by a chiropractor; the beneficiary is responsible for payment.Laboratory testsX-raysOffice visits (history and physicals)PhysiotherapyTractionSuppliesInjectionsDrugsEKGs or any diagnostic studyOrthopedic devicesNutritional supplements/counselingAny service ordered by the chiropractorDocumentation RequirementsAll documentation must be maintained in the patient's medical record and made available to the contractor upon request.Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.