What are the covered chiropractic services under Medicare?

Spinal manipulation treatment is a covered service under Medicare. However, Medicare considers only acute and chronic services as active care, and therefore, reimburse chiropractors for these services.

Can I bill for maintenance therapy give to my patients?

Medicare only covers acute/corrective treatment to correct acute or chronic subluxation. Medicare does not cover CPT code for chiropractic maintenance.

Do I need to submit a secondary diagnosis during claim submission?

Claim submission must include a primary diagnosis of subluxation and a secondary diagnosis reflecting the patient’s neuromusculoskeletal condition. You must document everything related to the services provided to support your claims.

Can I use pain levels to support acute or chronic category of subluxation?

No, you must clearly define the acute or chronic category of subluxation in the patient’s record.

Should I document the effectiveness of the treatment for all subsequent visits for a patient?

Yes, the documentation must indicate an evaluation of the effectiveness of the treatment provided for all subsequent visits.

Do insurance companies deny claims for chiropractic services based on medical necessity?

Insurance companies request chiropractors to send medical records to substantiate the chiropractic services rendered to a patient. If you met the documentation requirements, the claim reviewers send the documentation to a consultant to determine the medical necessity of the services. The insurers can deny claims if they didn’t deem a procedure medically necessary.

How can a subluxation be demonstrated?

A subluxation may be demonstrated by an X-Ray or by physical examination.

What is modifier AT and when do I report it?

Modifier AT tells us the difference between active treatment and maintenance treatment. When you’re billing Medicare, use AT modifier only when you bill for active/corrective treatment. Claims that do not contain modifier AT will be denied. AT modifier should not be used for maintenance therapy.

Is there a visit limit for chiropractic services as per Medicare?

There is no limit in Medicare for covered chiropractic care services as long as you meet Medicare’s licensure and other requirements.

Is participating and non-participating chiropractors have different documentation requirements?

The chiropractic industry has specific documentation requirements. Your participating status nothing to do with documentation requirements. Make sure you stay compliant with HIPAA for maintaining and storing patient data.

Chiropractic Codes Archives

Chiropractic Billing and Coding

by zhealth | May 20, 2022

Read this Chiropractic Billing and Coding guide to find out: The basics of chiropractic medical billing and coding to save your valuable time and money. Challenges you may be facing in billing insurance companies and their solutions. Chiropractic insurance billing,...

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