Modifiers are essential in chiropractic billing as they provide additional information to clarify the chiropractic services rendered, helping to prevent claim rejections, ensure proper reimbursement, and avoid audits. Modifiers are two-character alphanumeric codes are added to CPT codes to indicate distinct procedures, medical necessity, or other specific circumstances. Check out the infographic below for a visual guide to chiropractic billing modifiers and best practices!
Key Modifiers for Chiropractors:
- Modifier 25: Indicates that an Evaluation and Management (E/M) service was performed on the same day as a procedure.
- Modifier 59: Separates distinct procedures done on the same day.
- Modifier AT: Used for medically necessary chiropractic care for acute or chronic subluxation.
- Modifier GA: Applied when a service is non-covered by Medicare, often for maintenance care.
- Modifier GY: Indicates non-covered services like X-rays or tests, but not chiropractic adjustments.
Best Practices:
- Know when to use each modifier for the correct situation.
- Document thoroughly to justify the need for each modifier.
- Use Medicare-specific modifiers (like XE, XS, XP, XU) for more precise coding.
- Double-check modifier combinations to ensure they are used correctly together.
- Stay updated on payer policies to ensure compliance with insurer requirements.
By mastering modifier use, chiropractors can avoid billing errors, improve claim success, and streamline their practice’s financial management.
To learn how zHealth’s billing software can help you streamline your billing process and improve reimbursement rates, please contact us here.
