Chiropractic Medicare - Modifiers
Updated: March 15, 2011
Dear Doctors and Staff,
When billing for the Chiropractic adjustment and non-covered services, modifiers are a must. When billing 98940, 98941 and 98942, the "AT" modifier is necessary to tell the Medicare carrier - this is "active treatment" and to consider payment for this service. This does not mean they will automatically pay.
If the doctor, after making an assessment of the patient each and every visit, believes Medicare may not pay for this covered service he/she may ask the patient to sign an ABN. All payable services 98940, 98941 or 98942 will be followed by "AT" and "GA" modifiers.
The lack of "AT" modifier after a payable service means the doctor is not asking the Medicare Carrier to consider this service as a payable service and in doing so they are telling the carrier NOT to pay. That is usually a mistake because the adjustment to correct a subluxation is the only thing Medicare reimburses. The doctor needs to learn to document correctly so the covered services in Medicare are reimbursed.
The "GX" modifier is only used when non-covered services are billed to Medicare. This is done to receive a denial EOB for supplemental insurance. This information and much, much more is covered in our DVD.
BOTTOM LINE: If you wish to learn how to do Chiropractic Medicare correctly, including "documenting" by federal standards, please consider ordering our Chiropractic Medicare DVD and booklet. It explains piece by piece every important step in doing and billing Chiropractic Medicare so there are no limits for the chiropractic adjustment. If you are audited you will have done Medicare correctly and win your audit. You and your staff will be very happy you have this important and mandatory information. I promise it will make a difference in your understanding of Medicare and how you bill Medicare.
Keep in mind, Medicare is the only insurance type program that if done incorrectly is fraud, a felony, a fine and/or jail.
I promise you will be more than satisfied that you made the right decision to purchase this information or attend our presentation. Please give me a call if you have questions. 1-618-395-3162
Dr. Gary R. Street