Medicare Coverage For Chiropractic Manipulative Treatment (CMT)

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Medicare Coverage For Chiropractic Manipulative
Treatment (CMT)
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Medicare Coverage For Chiropractic Manipulative
Treatment (CMT)
Chiropractic Manipulative Treatment (CMT) is a
form of manual treatment to influence joint and
neurophysiological function. This treatment may
be accomplished using a variety of techniques.
Medicare covers limited chiropractic services
when performed by a chiropractor who is licensed
or legally authorized to furnish chiropractic
services by the State or jurisdiction in which
the services are furnished. For eligibility as a
chiropractor, you can refer, CMS Publication
100-01, Medicare General Information, Eligibility
and Entitlement Manual, Chapter 5, Section 70.6.
A chiropractor must also meet uniform minimum
standards as set forth in the CMS Internet-Only
Manual (IOM). In this article, we shared coding
guidelines and Medicare coverage for Chiropractic
Manipulative Treatment (CMT). Medicare
Coverage The patient must have a significant
health problem in the form of a
neuromusculoskeletal condition necessitating
treatment, and the manipulative services rendered
must have a direct therapeutic relationship to
the patients condition and provide reasonable
expectation of recovery or improvement of
function. The patient must have a subluxation of
the spine as demonstrated by x-ray or physical
exam. Most spinal joint problems fall into the
categories acute subluxation and chronic
subluxation. The term physician under Part B
includes a chiropractor who meets the specified
qualifying requirements set forth in 30.5 but
only for treatment by means of manual
manipulation of the spine to correct a
subluxation. Coverage extends only to treatment
by means of manual manipulation of the spine to
correct a subluxation provided such treatment is
legal in the State where performed. All other
services furnished or ordered by chiropractors
are not covered.
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Medicare Coverage For Chiropractic Manipulative
Treatment (CMT)
No other diagnostic or therapeutic service
furnished by a chiropractor or under the
chiropractors order is covered. This means that
if a chiropractor orders, takes, or interprets an
x-ray, or any other diagnostic test, the x-ray or
other diagnostic test, can be used for claims
processing purposes, but Medicare coverage and
payment are not available for those services.
This prohibition does not affect the coverage of
x-rays or other diagnostic tests furnished by
other practitioners under the program. For
example, an x-ray or any diagnostic test taken
for the purpose of determining or demonstrating
the existence of a subluxation of the spine is a
diagnostic x-ray test covered under 1861(s)(3)
of the Act if ordered, taken, and interpreted by
a physician who is a doctor of medicine or
osteopathy. Medicare does not cover chiropractic
treatments to extraspinal regions (CPT 98943).
The five extraspinal regions are head (including
temporomandibular joint, excluding
atlanto-occipital) region lower extremities
upper extremities rib cage (excluding
costotransverse and costovertebral joints) and
abdomen. For Medicare purposes, a chiropractor
must place an AT modifier on a claim when
providing active/corrective treatment to treat
acute or chronic subluxation. However, the
presence of the AT modifier may not in all
instances indicate that the service is reasonable
and necessary. As always, contractors may deny if
appropriate after medical review. Modifier AT
must only be used when the chiropractic
manipulation is reasonable and necessary as
defined by national policy. Modifier AT must not
be used when maintenance therapy has been
performed. The need for a prolonged course of
treatment should be appropriate to the reported
procedure code(s) and medical necessity must be
documented clearly in the medical record.
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Medicare Coverage For Chiropractic Manipulative
Treatment (CMT)

• Coding Guidelines
• The precise level of the subluxation must be
  listed.
• The date of the initial treatment or date of
  exacerbation of the existing condition must be
  entered in Item 14 of the CMS-1500 form or the
  electronic equivalent.
• If using an x-ray as documentation of the
  subluxation, the date of the x-ray (or existing
  MRI or CT scan) must be entered in Item 19 of the
  CMS-1500 form or the electronic equivalent.
• If an authorized ordering practitioner orders the
  x-ray, then he/she should enter his/her name in
  Item 17 of the CMS-1500 form and his/her own NPI
  number in Item 17a of the CMS-1500 form, or the
  electronic equivalent, as the ordering physician.
• The HCPCS modifier AT (acute treatment) must be
  appended to the chiropractic manipulation code to
  indicate the manipulation was for medically
  necessary and reasonable treatment of an acute
  subluxation or chronic subluxation as defined in
  national policy and the LCD.
• The AT modifier must not be placed on the claim
  when maintenance therapy has been provided.
  Claims without the AT modifier will be considered
  as maintenance therapy and denied.
• For claims submitted to the Part B MAC All
  services/procedures performed on the same day for
  the same beneficiary by the physician/provider
  should be billed on the same claim.
• Procedure codes 98940 98941 and 98942
  Chiropractic manipulative treatment Spinal
  1-2/3-4 5 regions) are used to bill chiropractic
  manipulative treatment.

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Medicare Coverage For Chiropractic Manipulative
Treatment (CMT)
Medisys Data Solutions is a leading medical
billing company providing assistance in complete
medical billing and coding functions for various
medical specialities. We can guide your
chiropractic practice to receive accurate
insurance reimbursements from private and
government payers. To know more about our
chiropractic billing services, contact us
info_at_medisysdata.com/ 302-261-9187
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