Medicare Archives - Chiropractic Billing And Coding

Medicare Non-Covered Services

In the Medicare program the only covered service for a Chiropractor is the Chiropractic Manipulative Therapy (CMT) – the adjustment. ALL other services are non-covered and should be modified with a GY modifier indicating that the service is a non-covered service. You are NOT required to file non-covered services to Medicare. As a matter of fact, […]

Medicare Fees in the Chiropractic Office

How much you should bill to Medicare and how much you should collect from the patient is dependent upon several factors: Is the doctor a participator Is the doctor a non-participator not accepting assignment Is the doctor a non-participator accepting assignment What is the Medicare fee schedule for your state and region Is Medicare traditional […]

Charging Full Fee for Medicare Adjustment

Once a Medicare patient has completed his treatment plan he should be treated thereafter on maintenance care which is not payable under Medicare rules. Although maintenance adjustments are not payable, they are still a covered service and must be filed. In order for you to be paid for these adjustments the patient should sign an […]

X-Ray Date No Longer Required

In days past if you depended upon an x-ray to demonstrate subluxation, you were required to show the date of the x-ray in block 19 in the claim form. For example: This is no longer required. Currently, any date placed in item 19 is considered date of last x-ray. It is recommended that providers do […]

Medicare Card

A Medicare card is issued to every person who is entitled to Medicare benefits and may be identified by its red, white and blue coloring. (See also Railroad Medicare) This card identifies the Medicare patient and includes the following information: • Name • Medicare Number (a randomized alphanumeric number – Medicare cards that bear the […]

Comprehensive Error Rate Testing (CERT)

The CERT program is designed to determine if Medicare contractors are processing and paying claims correctly. The Centers for Medicare and Medicaid Services (CMS) developed the CERT program to determine national, contractor specific, provider compliance error rates, paid claims error rates, and claims processing error rates. Every month, the CERT contractor selects a random sample […]

Medicare Patients with Part A Only

The only service covered by Medicare for a Chiropractor is the adjustment (98940, 98941 & 98942). All services other than adjustments should be charged to the patient at your regular fee (unless the service is a bundled service). Chiropractic is covered under Medicare Part B which is for physician services. Medicare patients can choose to […]

Requirement to Transmit Records Electronically

Quality Improvement Organizations (QIO) manage all Medicare beneficiary complaints and quality of care reviews to ensure consistency in the review process. When a QIO receives a written complaint about the quality of services received by a Medicare beneficiary, the QIO will request a copy of the medical record. The Centers for Medicare and Medicaid Services […]

PQRS Pain Assessment G Codes Retired

Physician Quality Reportins System pain assessment G codes have been retired as of 12-31-2020: G8730 – pain assessment documented positive AND follow-up plan documented G8731 – pain assessment documented as negative, no follow-up plan required G8442 – patient not eligible for pain assessment for documented reasons G8732 – pain assessment not documented, reason not specified […]

Active/Corrective vs Maintenance

Contrary to popular belief, there are no caps/limits for covered chiropractic care. There may be review screens (numbers of visits at which the Medicare carrier may require a review of documentation), but caps/limits are not allowed. The Social Security Act provides that Medicare will only pay for items or services it determines to be “reasonable […]

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