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chewri

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Can 98943 and 98941-51 be used? If not what should I be using. We are getting denied for this from commercial ins as well as MCR products.
Thanks in advance for your help.
Cheryl
 
98941/43

98941, 98943-51 is the correct order for billing. Sometimes 98943 will be billed alone, but that is very rare that a patient will have an extremity adjustment without a spinal manipulation.

Medicare will not pay for any extremity manipulations and some commercial insurances will not pay for 98943 without a spinal manipulation.

I agree with Jasmine, I know this to be true, but I can't find documentation in the CPT manual.
 
We bill 98941 and 98943. No modifier unless it is Medicare. Medicare does not pay for extra spinal and some insurance companies do not also. Check your contract and guidelines.
 
I never use a modifier 51 with 98943

I'm in Alaska and bill for quite a few chiropractors. We just bill 98941 and 98943 or 98940 and 98943. Have no issues. If you're billing medicare then it would be 98941-AT and 98943-GY.
 
In Ohio, no Mod 51

98941 is a spinal adjustment code. 98943 is an extremity adjustment code. I would suggest not using modifier 51. It sounds like your payer doesn't accept it b/c it isn't necessary to designate it as additional services.
 
You shouldn't need modifier -51 on the 98943 (though check with the individual payer). The 98941 is the primary procedure and 98943 is second. Additionally, the 98941 should have the dx pointer to the 3-4 spinal region codes and the 98943 should have be pointed to the extra-spinal (extremity) code(s). If the payer only covers spinal manipulation, not extremity, then you'll want to have your patient sign a non-covered benefit agreement prior to the service (check with each payer forms link, as they may require you to use their specific form otherwise you can create your own).
 
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