Understanding Chiropractic Billing

Understanding Chiropractic Billing

Practices often utilize professional chiropractic billing services to ensure there are no errors that could affect reimbursement.

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Professional chiropractic billing services can help practices ensure better reimbursement since there are quite a few minute details to remember when coding for chiropractic manipulation.

Chiropractic manipulation of the spine is commonly recommended for neck pain, lower and upper back pain, and even shoulder or arm pain. This therapeutic technique is known to bring about good results, and is reported with the CPT codes from 98940 to 98943, though CPT code 98943 indicating extra-spinal chiropractic manipulative treatment in one or more regions is not covered by Medicare.

Coding for Chiropractic Manipulation Here are the CPT codes covered by Medicare.   

98940 – Chiropractic manipulative treatment of the spine covering up to two regions 98941 – Chiropractic manipulative treatment of the spine covering three to four regions 98942 – Chiropractic manipulative treatment of the spine covering five regions

The five spinal regions include cervical, thoracic, lumbar, pelvic and sacral. In the case of multiple treatment levels within a region, they must be billed as a single region. If treatment is carried out on L3, L4 and L5, only CPT code 98940 must be billed since only the lumbar region is involved. The primary subluxation diagnosis plus the initial visit date or that of the exacerbation of the existing condition must be included in the claim.

HCPCS Modifiers to Use Billing must be done with the HCPCS modifier that appropriately describes the services.  

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AT modifier must be used while providing active or corrective treatment for chronic or acute subluxation.

Adding a GA modifier indicates that you believe Medicare could deny a service as unreasonable and unnecessary and you therefore have an ABN (Advance Beneficiary Notice) on file signed by the beneficiary.

A GZ modifier indicates that you expect Medicare to deny a service or item as unreasonable and unnecessary and you do not have a beneficiary-signed ABN.

How a Chiropractic Billing Company Can Help Chiropractic billing services involve tracking chiropractic treatment claims from Medicare and the commercial insurance providers. Medicare does provide chiropractic coverage under quite limited circumstances. Chiropractic is covered under Part B only if spinal manipulation for correcting a subluxation is involved. The costs for X-rays and other tests or

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services involved in the chiropractic treatment are not covered and must be borne by the beneficiary. Medicare Advantage Part C managed care plan is slightly broader in its chiropractic coverage.

With commercial insurance claims there could be issues such as complex documentation requests, payment routinely postponed, and reduced fee reimbursement. Outsourcing chiropractic billing to experienced chiropractic billing company can ensure that all the documentation requirements are handled efficiently to avoid your practice from encountering such issues from commercial providers. It also ensures timely claim filing, while the follow-up is done more aggressively and consistently.

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1-800-670-2809