CHIROPRACTORS BILLING FOR PHYSICAL THERAPY
Chiropractors billing for physical therapy services (CPT codes 97001–97799 and HCPCS code G0283) must bill with the appropriate modifier.
* GN – Services delivered under an outpatient speech-language pathology plan of care.
* GO – Services delivered under an outpatient occupational therapy plan of care.
* GP – Services delivered under an outpatient physical therapy plan of care.
Even though physical therapy billed by a chiropractor is a program exclusion, if one of the above modifiers is omitted from any of the codes referenced, the service will be rejected. This rejection would require the claim to be corrected and resubmitted.
CODING GUIDELINES
* The level of subluxation must be specified on the claim and must be listed as the primary diagnosis, i.e., cervical region (7391). The neuromusculoskeletal condition necessitating the treatment must be listed as the secondary diagnosis.
* Non-covered services provided by a chiropractor need not be billed to Medicare unless the patient requests the services be billed to obtain a denial for his supplemental insurance. The chiropractor may bill the services with specific procedure codes for the non-covered services, e.g., X-rays, laboratory tests, physical examinations or physical therapy. One exception to this situation exists: A chiropractor will still be required to bill Medicare for manipulations that exceed the norm and maintenance therapy.
CLAIM REQUIREMENTS
* The initial date of treatment must be documented in Item 14 of the CMS-1500 claim form or the electronic equivalent.
* If the subluxation is demonstrated by an X-ray, the X-ray date must be placed in Item 19 of the CMS-1500 claim form or the electronic equivalent.
Complete claim form instructions can be found at:
http://www.trailblazerhealth.com/Publications/Training Manual/claim form instructions.pdf
