CMT and E/M Reimbursement Solutions Coding Policy from ACA

The American Chiropractic Association (ACA) is the profession’s coding authority; payers often seek guidance from them on coding matters. One of the most common questions plaguing our profession is related to the use of Chiropractic Manipulative Treatment (CMT) codes with Evaluation and Management (E/M) Services on the same date. We know that many payers have adopted a policy that forbids both services being paid on the same date of service, and some even state that E/M services are only payable once or twice per patient. Here is the ACA’s position statement on this matter; we suggest that it be used as practices appeal arbitrary denials of one or both services when billed on the same date.

The following statement reflects the ACA’s position on the use of CMT codes and E/M Services.

As outlined in the AMA’s Common Procedural Terminology (CPT)© Book, there are instances when it is appropriate to bill a CMT and an E/M code together on the same date of service. It clearly states that:

“The physician work component of the CMT codes includes a brief pre-manipulation patient assessment. Additional evaluation and management services may be reported separately using the modifier -25 if, and only if, the patient’s condition requires a significant separately identifiable E/M service, above and beyond the usual pre-service and post-service work associated with the procedure.

The E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. If the patient presents more than one specific area of complaint that necessitates separate and distinct clinical evaluations on any given visit, E/M service codes should be the service that most accurately reflects the cumulative level of all services provided during the visit. As such, different diagnoses are not required for the reporting of the E/M service on the same day.”

Some examples of when it is appropriate to bill a separate E/M code on the same day as a CMT code include:

    • New patient visits
    • Established patients with new conditions
    • New injuries
    • Re-injuries
    • Aggravation
    • Exacerbation
    • Re-evaluation to determine if a change in treatment plan is necessary

Use of E/M services should be supported by appropriate documentation. The ACA recommends that all physicians use the E/M documentation requirements developed by the AMA and CMS.

When CMT and E/M codes are billed together, you must attach a -25 modifier to the E/M code (e.g., 99212-25). The -25 modifier signals the payer that an additional service—above and beyond the usual pre- and post- service work associated with the CMT code—was performed.