chirocodes for medicare

[sreelaly2k4@yahoo.co.in]

Hello all,

Am new to chiropractic coding , according to my knowledge regarding chiro cpts code range(98940-98943).Is there any seperate codes on chiropractic services for billing medicare patients.please guide me regarding the same...

Thanks,
Sreelal MSc ,CPC

[dballard2004]

I am not aware of any additional codes for chiropractic services for Medicare other than the ones you have outlined above. Medicare does not cover code 98943 for extraspinal treatment. You also need to make sure you append HCPCS modifier AT (acute treatment) to codes 98940-98942 in order to distinguish corrective treatment versus maintenance therapy. If the treatment is for corrective therapy, then you need to append the AT modifier. If the treatment is for maintenance therapy, then the AT modifier is not needed. Medicare does not cover maintenance therapy. Any claims you submit without the AT modifier will be denied as Medicare will assume these are for maintenance therapy.

[sreelaly2k4@yahoo.co.in]

Very informative Dowson,thanks a lot..

I have some more clarifications regarding chiro coding..

1)For physical therapy codes (97530,97110,97112,97140,97535,97014,97035,97012) any modifier need to be added for medicare insurance.

2)For supplies (biofreeze,orthotics,electrodes,lumbar pillow,lumbarbelt,cervical pillow,exercise ball,ice pack) should we give HCPCS code for medicare insurance or 99070.

Your response will be highly appreciated..

Thanks,
Sreelal MSc, CPC

[dballard2004]

Sreelal,

1. When billing PT services to Medicare, HCPCS Level II modifier GP (Services delivered under an outpatient physical therapy plan of care) must be appended to certain codes. The codes you have listed above, with the exception of code 97014, require the GP modifier if billed to Medicare.

For a complete list of PT services requiring the GP modifier, please reference CMS Transmittal 805: https://www.cms.gov/Transmittals/Downloads/R805CP.pdf.

Please keep in mind that Medicare requires the GP modifier. I would recommend checking with your commerical payers for their specific requirements for reporting PT services.

2. I would recommend reporting the specific HCPCS code for these supplies if possible in place of 99070. I am not sure, but I don't think that Medicare reimburses for supplies. As I stated above, I would recommend checking with your commerical payers for their specific requirements for PT services.

Hope this helps.

[sreelaly2k4@yahoo.co.in]

Thanks a lot for your help regarding chiro coding...

As per my research we can append AT modifier with manipulation codes(98940-98943)for medicare claims..

Am still confused with the usage of mod GY,and GP-GY combined..
can you please guide me regarding the same...Is it mandate to append GP-GY with PT codes..

Thanks,
Sreelal MSc,CPC

[dballard2004]

Sreelal,

If you are billing Medicare for PT services, you are mandated to report the GP modifier on certain codes. Those codes that require the GP modifier can be found in CMS Transmittal 805.

As for modifier GY, this is used to report to Medicare that the services provided are not covered (statutorily excuded) by Medicare, but you are billing Medicare for the services anyway. This is generally done because the patient has secondary insurance, but in order to file the claim with the secondary payer, they must first have a denial from Medicare. The GY modifier helps to expidite this process.

Since Medicare does cover PT service to some degree, I don't think you would need the GY modifier.

[sreelaly2k4@yahoo.co.in]

Dowson thanks alot for your help and support..


By the information provided by you,
I can goahead with processing chiroclaims..



Thanks,
Sreelal MSc,CPC

[dballard2004]

You are most welcome!

[LLovett]

Is the chiro doing the therapy services? If so you do not use the GP modifier. GP indicates it was provided by a physical therapist.

Laura, CPC, CPMA, CEMC

[dballard2004]

Medicare does not limit the use of PT codes to physicial therapists alone. To my understanding, modifier GP is to be appended to the PT codes indicated in CMS Transmittal 805 regardless of who is performing the PT service.