It’s intriguing how insurance providers differ in their assessment of chiropractic coding. There is a notable discrepancy in their criteria for determining medical necessity, with some adopting more rigorous standards, while others classify similar services as experimental, investigational, or lacking evidence.<\/p>\n
Chiropractor billing encompasses submitting claims to insurance companies or third-party payers for services rendered by chiropractors. Accurate documentation and utilization of correct chiro billing codes<\/span>\u00a0for chiropractic<\/span>\u00a0are crucial for maximizing reimbursement.<\/p>\n Here are some common chiropractic billing and coding requirements According to the most recent United Healthcare Network Bulletin<\/a><\/span>, to align with Medicare billing protocols, ALL United Healthcare (UHC) claims, including those sent to UHC subsidiaries like Optum and UMR, will require the GP chiropractic billing modifier on therapy codes for payment to be considered for these services.<\/p>\n The following chiropractic billing codes require a GP physical therapy modifier, as appropriate.<\/p>\n 92507\u00a0\u00a0 92508\u00a0\u00a0 92526\u00a0\u00a0 92608\u00a0\u00a0 92609\u00a0\u00a0 96125\u00a0\u00a0 97012\u00a0\u00a0 97016\u00a0\u00a0 97018\u00a0\u00a0 97022\u00a0\u00a0 97024\u00a0\u00a0 97026\u00a0\u00a0 97028\u00a0\u00a0 97032\u00a0\u00a0 97033\u00a0\u00a0 97034\u00a0\u00a0 97035\u00a0\u00a0 97036\u00a0\u00a0 97039\u00a0\u00a0 97110\u00a0\u00a0 97112\u00a0\u00a0 97113\u00a0\u00a0 97116\u00a0\u00a0 97124\u00a0\u00a0\u00a0 97139\u00a0 97140\u00a0\u00a0 97150\u00a0\u00a0\u00a0 97530\u00a0\u00a0 97533\u00a0\u00a0 97535\u00a0\u00a0 97537 \u00a0\u00a097542\u00a0\u00a0 97750\u00a0\u00a0 97755\u00a0\u00a0 97760\u00a0\u00a0 97761\u00a0\u00a0 97762\u00a0\u00a0 97799\u00a0\u00a0 G0281\u00a0\u00a0 G0283\u00a0\u00a0 G0329<\/p>\n Please note that some of these CPT codes are not applicable to the practice of chiropractic; however, the 97*** series of chiro CPT codes<\/span> (including electrical muscle stimulation, therapeutic exercise, etc) are commonly utilized in chiropractic clinics.<\/p>\n So if you render and bill for 1-2 regions of CMT (98940) and therapeutic exercise (97110), then the 97110 chiropractic CPT code<\/a> will receive the GP modifier.<\/p>\n 97014 \u2014 This code is designed to cover unattended electrical stimulation that is not a part of wound care treatment. (Note: 97014 is not recognized by Medicare.) In accordance with CMS guidelines, chiropractors must use the code G0283 for Medicare patients. Regardless of areas treated, don\u2019t bill 97014 more than once per patient encounter. Also, if you bill the CPT code 97014 when the payer requires the alternative HCPCS code G0283, your claim will be denied. It\u2019s crucial to note that United Health Care requires the same G0283 instead of 97014. When billing for chiropractic services in case of electrical simulation, makre sure to remember this. The charges for the electrodes are included in the practice expense portion of code G0283. Do not bill the Medicare contractor or the patient for electrodes used to provide electrical stimulation as a clinic modality. Do not bill Medicare for unattended electrical stimulation using code 97014.<\/p>\n Make sure when using your chiropractic billing software<\/a>\u00a0for submitting claims, you use HCPCS code G0283 for submission of electrical muscle stimulation treatment to Medicare and the CPT code 97014 to other insurance payers unless the payer\u2019s direction states otherwise. CPT Code\u00a097010<\/strong><\/span> is defined as “Any physical agent applied to produce therapeutic changes to biologic tissue; includes but not limited to thermal, acoustic, light,\u00a0mechanical, or electric energy. The application of a modality that does not require direct (one-on-one) patient contact by the provider. Application of a modality to one or more areas; hot or cold packs.<\/p>\n Chiropractic CPT code 97010 is often misused and over-billed. The most common reason is that it\u2019s difficult to establish and prove medical necessity for this service. The\u00a0documentation doesn\u2019t include an appropriate rationale for using this code. Here\u2019s what the American Chiropractic Association (ACA) has to say about code 97010:<\/p>\n \u201cIt is the position of the American Chiropractic Association that the work of hot\/cold packs as described by CPT code 97010 is not included in the common chiropractic CPT codes<\/span> 98940-43 in instances when moist heat or cryotherapy is medically necessary in order to achieve a specific physiological effect that is thought to be beneficial to the patient. Indications for the application of moist heat include, but are not limited to, relaxation of muscle spasticity, induction of local analgesia and general sedation, promotion of vasodilation, and increase in lymph flow to the area. Indications for the application of cryotherapy include, but are not limited to, relaxation of muscle spasticity, induction of local analgesia and general sedation, promotion of vasodilation, and increase of lymph flow to the area.\u201d<\/em><\/p>\n Medicare considers CPT Code 97010 (hot\/cold packs) a \u201cbundled\u201d service. When a service is bundled, it means that the reimbursement for the code is built into or grouped with the reimbursement for another code. It means hot\/cold pack services described by the CPT code for chiropractic – <\/span>97010 – are not separately billable when rendered to a Medicare patient. So 97010 will be a part of the primary service rendered to the patient, and in chiropractic, that will be a CMT code (98940-98942).<\/p>\n While some insurance payers operating as secondary to Medicare will cover 97010 when delivered in a chiropractic setting as a separate item. Do remember to include supportive documentation when billing for chiropractic services – hot or cold pack therapy CPT Code 97010:<\/p>\n According to the CPT manual, mechanical traction is described as the force used to create a degree of tension of soft tissues and\/or to allow for separation between joint surfaces. The\u00a0degree of traction is controlled through the amount of force (pounds) allowed, duration (time), and angle of pull (degrees)<\/em><\/strong><\/span>\u00a0using mechanical means. Terms often used in describing pelvic\/cervical traction are\u00a0intermittent\u00a0<\/em><\/strong><\/span>or\u00a0static\u00a0<\/em><\/strong><\/span>(describing the length of time traction is applied), or\u00a0autotraction\u00a0<\/em><\/strong><\/span>(use of the body’s own weight to create the force).<\/p>\n A common question is whether roller table-type traction meets the above requirement. Roller table-type traction normally meets the requirement of autotraction, the use of the body’s own weight to create the force. It is the position of the American Chiropractic Association that modalities such as mechanical traction are not included in the work of the CMT codes. Code\u00a097012<\/a> should be used to describe these services, subject to documented medical necessity. When you do chiropractor billing, make sure to document the type (e.g., static, intermittent, autotraction), amount of force (pounds), duration (time), and angle of pull (degrees).<\/p>\n When chiropractors provide therapeutic exercises to patients, they need to use the appropriate chiropractic insurance billing codes. These therapeutic exercises are typically designed to improve strength, flexibility, mobility, and fitness levels in patients. Here are the CPT codes most commonly used for therapeutic exercises in chiropractic care:<\/p>\n CPT Code 97110 – Therapeutic Exercises<\/p>\n CPT Code 97530 – Therapeutic Activities<\/p>\n CPT Code 97112 – Neuromuscular Reeducation<\/p>\n CPT Code 97535 – Self-Care\/Home Management Training<\/p>\n CPT Code 97113 – Aquatic Therapy<\/p>\n CPT code 97110<\/strong><\/span> (Therapeutic Exercise) is one of the most common chiropractor billing codes used for therapeutic exercises. This code incorporates one parameter (strength, endurance, and range of motion or flexibility) to one or more areas of the body. Examples include treadmill (for endurance), isokinetic exercise (for range of motion), lumbar stabilization exercise (for flexibility), and gymnastic ball (for stretching and strengthening).<\/p>\n Diagnoses could be:<\/p>\n Loss or restriction of joint motion, strength, flexibility, functional capacity, or mobility from a specific disease or injury.<\/p>\n Consider\u00a0chiropractic ICD-10 codes\u00a0from the following groups:<\/p>\n M47 M48 M50 M51 M53 M54 M62 M99 S13 S16 S23 S29 S33 S36 S39<\/p>\n CPT code 97530<\/strong><\/span> is therapeutic activities, direct (one on one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes. This procedure involves using functional activities (e.g., bending, lifting, carrying, reaching, catching, and overhead activities) to improve functional performance in a progressive manner.<\/p>\n Therefore, dynamic activities that work towards functional performance such as lifting, bending, pushing, pulling, jumping, and reaching would be billed as 97530.<\/p>\n Coders should determine how many outcomes are expected by the particular procedures being performed.<\/p>\n The takeaway is that if the documentation shows that the patient has a loss of strength, range of motion, endurance, or flexibility, then 97110<\/a><\/span>\u00a0can be justified.\u00a0 However, the treatment goals for exercise should clearly document anticipated improvement in those same parameters.<\/span><\/p>\n Remember, therapeutic exercises and therapeutic activities should be clearly described in your initial treatment plan and document the intended clinical outcome as well as how the procedure is performed.<\/p>\n For chiro billing,<\/span>\u00a0you can only quantify the time that is spent with direct patient-chiropractor care; the client waiting for equipment or resting in your office doesn\u2019t qualify as direct care, so it can\u2019t be billed.<\/span><\/p>\n Refer to these ranges of billing codes for chiropractic to find the one that is most appropriate for chiropractic services rendered:<\/span><\/p>\n These therapy services which require direct (one-on-one) patient contact (97032-97039, 97110-97150 and 97530-97546) may only be billed if provided by a licensed provider or therapist. Use these chiropractor billing codes when the service was provided by a skilled therapist and operating within the scope of their license.<\/p>\n Chiropractic billing can be challenging due to the complex chiro CPT codes and documentation requirements. However, with the right <\/span>chiropractic billing tips and tricks<\/a>, practices can streamline their billing processes, increase revenue, and provide better service to their patients.<\/span><\/span><\/p>\n If in-house billing is too demanding for you and your staff, zHealth will reviews your chiropractic billing codes before claim submission<\/span> so you can get the maximum possible reimbursement. We offer a comprehensive range of chiropractic medical billing services<\/a> including coding review, AR follow-up, denial management, payment posting, credentialing, and more. Our chiropractic billing software makes it easier for you to keep track of all submitted claims and ERAs\/EOBs. For in-detail information about how we can help you achieve maximum reimbursement, contact us right away.<\/p>\n Request a Demo<\/a><\/span><\/strong><\/p>\n <\/span><\/strong><\/p>\n Related Articles:<\/span><\/strong><\/p>\n The \u2018Tricky\u2019 97140 Chiropractic CPT Code: How to Use This Code Appropriately<\/a><\/p>\n Know the Top Chiropractic CPT Codes That Can Save Your Billing Time<\/a><\/p>\n 5 Modifiers That Are Necessary on Chiropractic Claims<\/a><\/p>\n1. <\/b>UHC Claims Will Require GP Modifier For Therapy Codes<\/b><\/h2>\n
2. Don’t Bill 97014\/G0283(Electrical Stimulation) More Than Once Per Patient Encounter<\/b><\/h2>\n
3. The 97010 CPT Code is Described in the CPT Manual as Supervised Modality\u00a0\u00a0<\/b><\/h2>\n
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4. Procedure Codes 97012, Mechanical Traction\/Spinaltor<\/b><\/h2>\n
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<\/a><\/p>\n5. 97110 Therapeutic Exercise vs 97530 Therapeutic Activity<\/b><\/h2>\n
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6. Direct Patient-Chiropractor Care CPT Codes<\/strong><\/h2>\n
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<\/a><\/p>\nTips for Accurate Chiropractic Billing and Coding<\/strong> <\/span><\/h2>\n
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