Medlearn
Matters…Information for Medicare
Providers
(Issued by the Centers for
Medicare & Medicaid
Services)
|
Revised
Requirements for Chiropractic Billing of
Active/Corrective Treatment and Maintenance Therapy, Full
Replacement of CR 3063
| Note: |
This article is a full
replacement for the article released on
September 8 to clarify certain language
regarding denials. |
|
Provider Types Affected
Chiropractors
Provider Action Needed
Impact to You
Chiropractors have been submitting a very high rate of
incorrect claims to Medicare. Medicare only pays for
chiropractic services for active/corrective treatment
(those using HCPCS codes 98940, 98941, or 98942). Claims
for medically necessary services rendered on or after
October 1, 2004 must contain the Acute Treatment (AT)
modifier to reflect such services provided, or the claim
will be denied.
What You Need to Know
This
article completely replaces MM3063 on the same subject.
On or after October 1, 2004, when you provide acute or
chronic active/corrective treatment to Medicare patients,
you must add the AT modifier to every claim that uses
HCPCS codes 98940, 98941, or 98942. If you don’t
add this modifier, your care will be considered
maintenance therapy and will be denied because
maintenance chiropractic therapy is not considered
medically reasonable or necessary under Medicare.
What You Need to Do
Ensure that
your billing staff is aware that they must apply the AT
modifier to HCPCS codes 98940, 98941, or 98942 when your
clinical documentation reflects that the care you
provided to a Medicare patient consists of
active/corrective treatment. Additionally, your billing
staff should be aware of any LCDs for these services in
your area that might limit circumstances under which
active/corrective chiropractic can be paid.
Background
The 2003 Improper
Medicare FFS Payment report indicates that chiropractors
have the highest provider Compliance Error Rate in
Medicare, filing claims incorrectly almost one-third of
the time. Chapter 15, Section 30.5 of the Medicare
Benefits Policy Manual states that the Medicare program
does not consider chiropractic maintenance therapy as
medically reasonable or necessary, and is not payable
under the Medicare program. So, for you to bill Medicare
correctly, you need to indicate which of your claims are
for active/corrective therapy and which are for
maintenance therapy. A modifier (“AT”)
already exists that can be used for this purpose.
Therefore, you must place an AT
modifier on a claim when providing active/corrective
treatment to treat acute or chronic subluxation. For
services rendered on or after October 1, 2004, all of
your claims for active/corrective therapy (HCPCS codes
98940, 98941, 98942) that do not contain the AT modifier
will be denied. This is because, as mentioned above,
services without this modifier will be considered
maintenance therapy (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) and are not considered medically
reasonable or necessary under Medicare.
As always, your Medicare contractor may deny your
claim, if appropriate, after medical review.
For services that are maintenance therapy, you may
wish to obtain an Advance Beneficiary Notice (ABN) from
the beneficiary and also apply the GA modifier (to be
used when you want to indicate that you expect that
Medicare will deny a service as not reasonable and
necessary and that you do have on file an ABN signed by
the beneficiary) or the GZ modifier (to be used when you
want to indicate that you expect that Medicare will deny
an item or service as not reasonable and necessary and
that you have not had an ABN signed by the beneficiary),
as appropriate.
Important Dates to
Know
Effective Date: October 1,
2004
Implementation Date: October 4, 2004
Related Instruction
The
revisions to Chapter 15 of the Medicare Benefits Policy
Manual are attached to the official instruction released
to your carrier. That instruction may be found at:
http://www.cms.hhs.gov/Transmittals/
Once at that Web page, scroll down the CR NUM column
on the right to locate CR3449 and click on that file.
Also, you may check any LMRP/LCDs that may
apply to you at: http://www.cms.hhs.gov/mcd
For more information about the use of the ABN, consult
the Internet-Only Manual (IOM), Pub. 100-04, Chapter 23,
Section 20.9.1.1. You can access this information at:
http://www.cms.hhs.gov/manuals/104_claims/clm104c23.pdf
Additional Information
If you
have any questions, please contact your carrier at their
toll free number, which may be found at: http://www.cms.hhs.gov/MedlearnProducts/downloads/CallCenterTollNumDirectory.pdf
Disclaimer
Medlearn Matters articles are
prepared as a service to the public and are not intended
to grant rights or impose obligations. Medlearn Matters
articles may contain references or links to statutes,
regulations, or other policy materials. The information
provided is only intended to be a general summary. It is
not intended to take the place of either the written law
or regulations. We encourage readers to review the
specific statutes, regulations, and other interpretive
materials for a full and accurate statement of their
contents.
For more information, visit the Medlearn Matters Web
page at: http://www.cms.hhs.gov/MedlearnMattersArticles/
Related Change Release (CR) #:
3449
Medlearn Matters Number: MM3449
Related CR Release Date: October 8,
2004 Revised
Related CR Transmittal #: 23
Effective Date: October 1,
2004
Implementation Date: October 4, 2004
|
