Medical Billers be aware: Medicare will not pay Chiropractors if Modifier AT is not billed

Medical Billing for Chiropractic services seems easy enough. So, it came as a surprise to me when a medical billing service I consult for called me:

Jennifer, we are about to lose our new chiropractic provider because we can’t seem to get Medicare to pay out on his claims. We have called Medicare but they won’t help us with coding questions.

My question to them was, “Are you billing with Modifiers?” The response was a panicked, “Do we need to?”

YES!

If you are not familiar to medical billing for chiropractors let’s go over Medicare’s medical billing guidelines.

Chiropractors can bill the following procedure codes:
98940 Chiropractic Manipulation Treatment (CMT); Spinal, one or two regions
98941 Spinal 3-4 regions
98942, Spinal 5 regions

So, I know what you are thinking; what if the patient is treated for carpal tunnel, or knees popping can we bill for that? No, if the chiropractor treats anything outside of the spinal regions Medicare will not pay out on the claim.

Now the modifier gets a bit more interesting –
Modifier AT stands for Active/Corrective treatment and it needs to be billed when using the 3 procedure codes above. If you do not use it you are telling Medicare that this patient is being treated for maintenance therapy and therefore they will not pay.

So, in my example when my client called me saying they were getting denials Medicare wasn’t denying these claims they were sending the EOB to the client letting them know that they do not pay out on maintenance treatments.

How to get payment:
My suggestion would be to attach the modifier AT to each billed claim and rebill the medical HCFA 1500 claims as a corrected claim and request that they acknowledge the attached AT modifier.

**Medicare does not cover chiropractic treatment to extraspinal regions (CPT 98943), which includes the head, upper and lower extremities, rib cage, and abdomen.

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