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 prefers that you do not file them.

The only time that you would want to file the non-covered services is when Medicare is primary and there is a secondary insurance that might cover them after being denied by Medicare.

Medigap and Medicare supplemental policies are NOT secondary insurances and are automatically crossed over.

After your Medicare Administrative Contractor (MAC) processes your Medicare claim, it is transmitted to Baltimore where it is crossed referenced and checked for supplemental coverage. If supplemental coverage is found, the claim is automatically sent to the supplemental carrier. Therefore you don’t have to file the supplemental claim and the supplemental insurance information does not have to be shown on the claim form.

If you do file the non-covered services to Medicare it’s better if they are not filed on the same claim form with covered services. It actually takes longer for an insurance company to deny a service that to pay it so co-mingling covered and non-covered services on the same claim form will slow down payment.

There are situations when Medicare is the secondary insurance. In this case, the primary should of course be filed first then Medicare.

You do not have to file the Medicare secondary claim if the primary considers/pays as much as 100% of the Medicare approved charge (not the full fee). A short course in understanding Medicare fees is covered in our Medicare Payments Course

How to determine if Medicare is the secondary insurance is covered in our Medicare Course

See also GP modifier for therapies

FormSmith Software Users

FormSmith should automatically modify Medicare non-covered services with the GY modifier. If your non-covered services are not getting the GY modifier you should call support – something is not setup correctly in your system.

When setting up a patient that is Medicare eligible, you should indicate eligibility on the ‘demographics’ tab when editing the patient information. If you want to file the non-covered services, you must check ‘file (medicare) unapproved charges.’

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