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Chiropractic

Newsletter

New Zip Code Added to Medicare Chiropractic Demonstration Project

Date: 6/26/2006

Effective June 13, 2006, providers in the zip code 60502 for Aurora, Illinois will be eligible for participation in the Medicare Chiropractic Demonstration Project.

Source: Wisconsin Physicians Service (WPS Medicare)

Updated List of Procedures that Chiropractors Can Bill Under in 2006

Date: 3/27/2006 

Orthotics fitting and training, upper and/or lower

97504 was replaced with 97760

Checkout for orthotic/prosthetic use, established patient, each 15 minutes

 97703 was replaced with 97762

Microwave Modality

97020 was deleted and combined with CPT code 97024

Tensilon Test for Myasthenia Gravis with Electromyographic Recording

95858 was deleted.

Source: CMS ML Matters Article SE0514

Physical Therapy Caps Implemented

Date: 1/1/2006

Financial limitation of therapy services were implemented:

Physical Therapy / Speech -Language Pathology - combined annual limit for 2006 is $1740

Occupational Therapy - annual limit for 2006 is $1740

A therapy exception process is available that allows to override these limitations in certain situations. The exception process can take affect through automatic coverage exceptions for certain Diagnoses that are included on pp 22-24 of

CMS Transmittal 655 - Therapy Caps Exception Process.

If the automatic exception process is met, providers do not need to send documentation for these specific patients.

In addition, providers must submit claims with the KX modifier along with either the GN, GO, or GP modifiers. Provider's also must maintain documentation on file to be available if or when requested.

The second therapy exception process is to submit a request manually, along with supporting documentation. The request cannot exceed 16 future treatment visits. for each discipline of therapies.

To learn more about the exceptions process, please visit the CMS MLN Matters article.

 New Zip Codes Added To The Medicare Chiropractic Demonstration Project

 Date: 9/6/2005               

Effective September 6, 2005, zip codes 60586 and 60585 for Plainfield, IL will be included in the Chiropractic Demonstration Project.

Source: Wisconsin Physicians Service (WPS Medicare)

Revised Requirements for Chiropractic Billing of Active/Corrective Treatment and

Maintenance Therapy

Date: 10/01/2004

Effective on or after October 1. 2004, claims will require the Acute Treatment (AT)

modifier for procedure codes 98940, 98941 and 98942 to be considered medically

necessary to treat acute or chronic subluxation. If the AT modifier is not applied, the

claim will be considered as maintenance therapy and will be denied. Clinical

documentation should support the care that the provider is rendering to Medicare

beneficiaries.

Maintenance therapy is termed as "services that seek to prevent disease, promote

health, and prolong and enhance the quality of life; or maintain or prevent

deterioration of a chronic condition". Maintenance therapy is not considered medically

necessary.

For services that are considered "maintenance therapy", you can use the GA modifier

to indicate that an Advance Beneficiary Notice (ABN Form) is on file. The GA modifier

in this case indicates that you expect that Medicare may deny the service as not

reasonable or medically necessary and if the claim is denied as such, payment will be

the responsibility of the beneficiary.

Source: Centers for Medicare & Medicaid Services (CMS)