Medicare Archives

The Nuances of Medicare Billing

Medicare plays by its own set of rules. These rules may or may not follow those of other carriers. Medicare’s rules have a nuance all their own (e.g., chiropractors are one of three types of practitioners who can never opt out of Medicare). Medicare also has a specific set of modifiers that help make billing…

Oops, your level of membership doesn’t include access to these advanced materials. They are reserved for members working 1-on-1 with our specialists for analysis and training. Please reach out to the HelpDesk to learn more about accessing these materials. Click here to learn more.

Use of the AT Modifier in Chiropractic

Medicare publishes helpful documents and alerts to keep providers in the know about important topics. The use of the AT modifier in Medicare is one of the most critical billing issues providers face. Absence of the AT modifier indicates that the service is maintenance in nature…and therefore, is not payable. Statistics show that overuse of…

Medicare Diagnosis Rules

As with all treatments and services in chiropractic, Medicare has its own set of rules, policies, and procedures. It is particularly important to be clear about the diagnosis rules regarding Medicare patients. You should review Medicare’s guidance in your Local Coverage Articles, and revisit them frequently to stay on-top of any changes. Doing so will…

Idiosyncrasies of 97010-Hot/Cold Packs

ACA & CPT Code 97010 Code 97010 is often misused and overbilled. The most common reason is that it is difficult to establish and prove medical necessity for this service, and very often, the documentation does not include appropriate rationale for using this code. Below you will find what the American Chiropractic Association (ACA) has…

Billing Electric Muscle Stimulation to Medicare

Electrical Muscle Stimulation (EMS) Being Accepted by Medicare A common question in billing physical medicine codes to Medicare involves electrical muscle stimulation. Since Medicare is required to follow, and helps define CPT coding guidelines, why is the CPT code 97014 denied when billed to Medicare? And why is the CPT code 97014 often denied as…

Excluded Service Modifiers Can Make or Break Your Claims

Now that you’ve learned about the difference between modifiers for spinal CMT codes, and those for excluded services, let’s dig a bit more into two critical excluded service modifiers. The GP and GY modifiers may seem unimportant because they are appended to codes that are not covered by Medicare. But misuse or omission of either…