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I am fairly new to the Chiropractic world and had a question. To my understanding Medicare only covers Manipulation codes 98940 and 98941. If a doctor does an E-stim or a patient needs massage therapy is there any modifier to use to cover the other two codes. I do have ABNs implemented for these. Also how does your facility bill for patients who are only under "maintenance care".

Thank you


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Medicare questions

Medicare will only cover manipulations to the spine: 98940, 98941 and very rarely 98942. For maintenance care, we only bill Medicare when there is supplemental coverage that will pick up the charges. In this case, remove the AT before billing. (The exception is when the member wants Medicare billed for maintenance care even if there isn't supplemental coverage. Remove the AT, send to Medicare and bill the patient once you get the denail.)

Other treatments may be covered by supplemental insurance as well. In active treatment, leave the AT attached. Medicare will pay for the spinal manipulation and forward the bill to the secondary, which usually will pay the remaining charges.

An ABN should only be used when you know or suspect Medicare will not cover the charges; for example, when transitioning from active care to maintenance care, issue an ABN. Proper execution allows you to bill the patient for maintenance treatments which not covered by Medicare.

Things are murkier with Advantage plans. It is not appropriate to issue an ABN to an advantage plan member. Each plan has it's own rules for how you should let it's members know what is and isn't covered. We say wtf? Why make it more difficult! We often use a notice very like an ABN to let Advantage plan members know what is and isn't covered by Medicare.

Is this clear? It took me awhile to get it straight in my mind :) patti
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