CMT And E&M On The Same Visit

The chiropractic manipulative treatment (CMT) includes a pre and post service evaluation.

The insurance companies, to their advantage, interpret this to mean that the “pre and post service” constitutes an Evaluation and Management service. When a CMT and E&M occur on the same visit/day, they will generally pay the least expensive service (the CMT) and deny the more expensive service (the E&M) as a duplicate service.

There are situations in which some but not all insurance companies will allow a CMT and E&M on the same visit. For example when a CMT is filed with a new patient E&M.

Any time that you perform a CMT and E&M on the same visit, the E&M service should be modified with a 25 modifier.

E&M 99213 modified with 25 modifier

The bottom line is this. If you want to keep down denials and prevent having to resubmit services with reports …

Don’t Examine And Adjust On The Same Visit

Additional information about the 25 and 59 modifier can be found HERE