Well, for chiropractors, in my experience, most insurance carriers only allow the manipulation codes (98940-98943) or they have a global allowance for a chiropractic visit. However, there may be some commercial carriers who do allow for chiropractors to bill for modalities and/or range of motion testing. I can’t really tell you for sure when it will be covered. What I would recommend is including on bills for patients when the testing is performed, (you may want to use the 59 modifier to indicate distinct procedural service) in addition to the other codes (exam or manipulation). The best way to find out is to bill it. Another option is to contact provider reps for your largest insurance carriers and ask them if you are allowed to bill those codes.
Wednesday, January 23, 2008
Chiropractic Coding
We recently had a question on billing codes 95851 &/or 95832 in a chiropractic office. My advice to this office was:
Well, for chiropractors, in my experience, most insurance carriers only allow the manipulation codes (98940-98943) or they have a global allowance for a chiropractic visit. However, there may be some commercial carriers who do allow for chiropractors to bill for modalities and/or range of motion testing. I can’t really tell you for sure when it will be covered. What I would recommend is including on bills for patients when the testing is performed, (you may want to use the 59 modifier to indicate distinct procedural service) in addition to the other codes (exam or manipulation). The best way to find out is to bill it. Another option is to contact provider reps for your largest insurance carriers and ask them if you are allowed to bill those codes.
Well, for chiropractors, in my experience, most insurance carriers only allow the manipulation codes (98940-98943) or they have a global allowance for a chiropractic visit. However, there may be some commercial carriers who do allow for chiropractors to bill for modalities and/or range of motion testing. I can’t really tell you for sure when it will be covered. What I would recommend is including on bills for patients when the testing is performed, (you may want to use the 59 modifier to indicate distinct procedural service) in addition to the other codes (exam or manipulation). The best way to find out is to bill it. Another option is to contact provider reps for your largest insurance carriers and ask them if you are allowed to bill those codes.
Subscribe to:
Post Comments (Atom)
2 comments:
I HAVE A PROBLEM, IF ANYONE COULD ANSWER THIS IT WOULD REALLY HELP ME OUT
I HAVE A RIBC PT WE BILLED 98940, 97012, 97014 BC PAID THEIR ALLOWABLE FOR THE 98940 AND DID NOT PAY THE OTHER CODES, THE DOCTOR WANTS TO BILL THE 97012 AND 97014 TO THE PATIENTS ATTORNEY AS HE WAS INVOLVED IN A MVA, I SAY NO ITS NOT ALLOWED TO BALANCE BILL THE REMAINING CODES, AS BC PAID UP TO THE ALLOWABLE...SHE SAYS YES SHE CAN..... AM I RIGHT, WOULDNT THIS BE A VIOLATION OF HER BLUE CROSS CONTRACT?
The problem I see with the situation you described is that BCBS is being billed for charges relating to an MVA. Shouldn't the patient's No-fault insurance be billed?
In NY, our local BC allows $30 for a chiropractic visit. It is against the BCBS contract to balance bill the patient anything over the $30. However if the patient has a secondary insurance that does cover the modalities the secondary insurance can be billed for the modalities, as long as they are on the BCBS eob.
If BCBS is aware the services are related to an MVA and they still are processing them then it is ok to send a statement to the lawyer showing the actual charges and the amount BCBS allowed and paid. Then it is up to the attorney to decide how much is the patient's responsibility.
Sounds like a sticky situation.
Good Luck! :)
Michele
Post a Comment