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Chiropractic Services: Acute Treatment
The Centers for Medicare & Medicaid Services (CMS) requires that claims submitted for treatment of subluxation contain HCPCS modifier AT to reflect services rendered providing active/corrective treatment to treat acute or chronic subluxation. Clinical documentation must be available upon request to support use of all modifiers.
Claims received for active/corrective therapy (CPT codes 98940, 98941 or 98942) that are not submitted with HCPCS modifier AT will be considered maintenance therapy and will be denied because maintenance chiropractic therapy is not considered medically reasonable or necessary under Medicare.
When services are rendered for maintenance therapy (services that seek to prevent disease, promote health, and prolong and enhance the quality of life, or maintain or prevent deterioration of a chronic condition) providers may wish to obtain an Advance Beneficiary Notice (ABN) from the patient and apply the HCPCS modifier GA. HCPCS Modifier GA indicates that you expect that Medicare will deny a service as not reasonable and necessary and that an ABN has been signed by the patient. If you expect that Medicare will deny an item or service as not reasonable and necessary and the patient has not signed an ABN, submit HCPCS modifier GZ. Claim lines containing HCPCS modifier GZ will be automatically denied and will not be subject to complex medical review.
Medicare requires the individual who ordered/provided services be clearly identified in the medical records. The signature for each entry must be legible and should include the practitioner’s first and last name and applicable credentials, e.g., P.A., D.O. or M.D. For more information about signatures, please refer to the article titled "Medicare Part B Medical Records: Signature Requirements, Acceptable and Unacceptable Practices."