Overview of Coverage Requirements
The coverage of chiropractic services is precisely limited to treatment by means of manual manipulation (i.e., by use of the hands) of the spine to correct a subluxation. Subluxation is defined as a motion segment in which alignment, movement integrity, and/or physiological function of the spine are altered, although contact between joint surfaces remains intact. Let’s find more information on Medicare’s billing and Chiropractic Coding: CPT Codes 98940-98942.
Manual devices – the devices that can be controlled manually (e.g. those which are hand-held with the drive of the force of the device) might be used by chiropractors to perform manual manipulation of the spine. No extra payment is available for use of the device, nor does Medicare recognize an additional charge for the device itself.
Another diagnostic or therapeutic service not furnished by a chiropractor or under the chiropractor’s order is covered.
CPT Code 98940: Chiropractic manipulative treatment (CMT); Spinal, 1-2 regions
CPT Code 98941: Chiropractic manipulative treatment (CMT); Spinal, 3-4 regions
CPT Code 98942: Chiropractic manipulative treatment (CMT); Spinal, 5 regions
Number of Regions
|98940||Spinal (cervical region, (includes atlantooccipital joint); thoracic region (includes costovertebral and costotransverse joints); lumbar region; sacral region; and pelvic (sacroiliac joint) region)||1 or 2||
|98941||Spinal (cervical region, (includes atlantooccipital joint); thoracic region (includes costovertebral and costotransverse joints); lumbar region; sacral region; and pelvic (sacroiliac joint) region)||3 to 4||
|98942||Spinal (cervical region, (includes atlantooccipital joint); thoracic region (includes costovertebral and costotransverse joints); lumbar region; sacral region; and pelvic (sacroiliac joint) region)||5||
Improve insurance reimbursements
- Verify and know your patient’s insurance coverage. Two patients can have different insurance contracts with coverage from the same company. Contrariwise, one insurance carrier might reimburse for a specific CPT while the second one will deny it.
Verifying eligibility prior to each and every new patient appointment is therefore the essential first step in the claim revenue cycle. Also, you need to verify existing patient eligibility after a certain period.
- You have to complete pre-authorizations before starting treatment (if applicable). If the patient has the chiropractic benefits on their plan, your claims may be denied if there are pre-authorization requirements in place.
- Analyze denied claims. This can be the biggest issue that negatively affects revenue is Denied claims. In fact, according to the Government Accountability Office, up to 25% of insurance claims are denied. Once you analyze your denials, you can recognize patterns that can be corrected.
- Understand Medicare’s billing and documentation. Documentation has one of the highest error rates when Chiropractors bill to Medicare. This rate includes rejected and denied claims. Medicare only covers CPT codes 98941, 98942, 98943 for Chiropractic practice.
All other CPT codes billed to Medicare will be either deny or reject. Also, while submitting a claim to Medicare for manipulation, you must add the Acute Treatment (AT) modifier if you want to get paid.
- Properly document your patient encounters. To minimize the probabilities of triggering an audit and possibly paying penalty charges and fines, make sure to document your encounters properly. Your SOAP notes should specify the need for treatment, and contain treatment goals, objective measures for patient progress, the patient’s development, and the treatment plan.
The latter should include duration and frequency. Whenever you are going to bill Medicare, make sure all documentation is complete and according to established guidelines. Call us to know more about Chiropractic Coding and Billing Challenges, Solutions :Toll-Free: 888-357-3226.
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