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I'm relatively new to Chiropractic billing, especially when it comes to Medicare. I know that Medicare only pays for manipulations, but can I also bill an e/m code to Medicare for the initial visit?
Medicare will not pay for an E/M visit with a chiropractic manipulation. You may still bill for the exam if the denial is needed for secondary/supplemental insurance.
Your LCD, Local Coverage Determination, will cover exactly what procedures and diagnoses Medicare will cover. You can find a copy/download of your LCD at your MAC's website.
At the CMS website you will find information about ABNs which will enable you to collect for non-covered services from the patient.
I'm throwing around a lot of acronyms here, but if you need help or more detail, your state chiropractic association may have some valuable information.
I jsut re-read your post and want to be a bit more clear. Medicare will only pay for spinal manipulations, not extremity manipulation 98943. And Medicare will not pay for a chiropractor's E/M visit regardless of when the exam occurs. Good Luck!
Thank you so much for all the useful information. I had actually gone to the CMS website, but I couldn't find the answer specifically to E/M. I will take another look at the LCDs again. Thank you
I just downloaded the LCDs from the MAC's website and yes it is very helpful. What I find unfair is that the chiropractor is obligated to perform and document an E/M service but they are not reimbursed for that, that's why I assumed that it would be covered, but I stand corrected. Thanks again ladies for the information.