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Can an MD bill Chiropractic Codes?

Annette Posted Mon 05th of December, 2016 15:12:29 PM
Can an MD bill Chiropractic Codes? Can they bill 98940, 98941, 98942?
SuperCoder Answered Tue 06th of December, 2016 01:23:09 AM

Medicares Stringent Chiropractic Rules Medicare will not reimburse chiropractors for any treatment other than CMT using 98940-98942 (most Medicare carriers will not allow payment for extraspinal CMT [98943]). Section 2251 of the Medicare Carriers Manual (MCM) states, Coverage of chiropractic service is specifically limited to treatment by means of manual manipulation, listing examples of manual manipulation as spine or spinal adjustment by manual means; spine or spinal manipulation; manual adjustment; and vertebral manipulation or adjustment. Chiropractors also can bill Medicare for E/M codes when evaluating a patients condition, but Medicare will not pay chiropractors for other physical medicine codes. In addition, Medicare and most private insurers require a diagnosis of subluxation of the spine to demonstrate medical necessity for CMT billing. The MCM states that claims for CMT must indicate the precise location of the subluxation and lists two ways to specify the level of subluxation: The exact bones may be listed, for example, C5, C6, etc.; or the area may suffice if it implies only certain bones such as sacroiliac (sacrum and ilium). Private Insurers May Pay Chiropractors for PT Many private insurers will pay for physical therapy services provided by chiropractors, though this varies depending on state mandates and insurers rules. According to Patricia Niccoli, president of ElectroAge Billing, a medical billing firm in Phoenix, the only physical medicine codes that chiropractors specifically are barred from using on a national basis are 97001 through 97004. These codes, says Niccoli, are for physical therapy and occupational therapy evaluations and re-evaluations, because these therapists cannot use the standard E/M codes. In addition, says Niccoli, The scope of some chiropractors licenses may prohibit them from performing physical therapy.

Annette Posted Tue 06th of December, 2016 08:40:20 AM
Hi, Unless I am reading it wrong, I think you answered the opposite question. I was asking if a MD (primary care physician) can bill chiropractor codes not if a chiropractor can bill medical codes. Thanks!
SuperCoder Answered Wed 07th of December, 2016 02:05:13 AM

Yes, MD can bill Chiropractic Codes 98940, 98941, 98942.

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