September 2004

CMS issues revised requirements for chiropractic billing

The Center for Medicare and Medicaid Services (CMS) has issued revised requirements for chiropractic billing of active/corrective treatment and maintenance therapy.

According to CMS Benefits Policy Manual, chiropractic maintenance therapy is not medically reasonable or necessary and is not payable under the Medicare program. CMS states that “chiropractors have the highest Provider Compliance Error Rate in Medicare. The [2003 Improper Medicare FFS Payments] report indicates that chiropractors filed claims incorrectly almost a third of the time.”

The Medicare policy now states that the AT modifier should only be used when chiropractors bill for active/corrective treatment. It states that:

• Every chiropractic claim (those containing HCPCS code 98940, 98941, 98942) with a date of service on or after Oct.1, 2004, should include the Acute Treatment (AT) modifier if active/corrective treatment is being performed; or

• No modifier should be used if maintenance therapy is performed.

The policy directs contractors to deny a chiropractic claim (containing HCPCS code 98940, 98941 or 98942 with a service date on or after Oct. 1 that does not contain the AT modifier.

The revised requirements can be downloaded at www.cms.hhs.gov/providerupdate/whatsnew.asp. Online training on this revision will be available at www.cms.hhs.gov/medlearn/matters.

Source: Center for Medicare and Medicaid, www.cms.gov.

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