HCPCS Modifier AT

Description
Acute treatment (chiropractic).

Guidelines/Instructions
This modifier is submitted with chiropractic treatment codes when the chiropractor furnishes acute treatment.
  • This modifier may only be submitted with CPT codes 98940, 98941 and 98942. CPT code 98943 is not reimbursed by Medicare.
  • Documentation in the patient's medical record must support the active nature of the treatment when this modifier is submitted
  • Chiropractors must submit HCPCS modifier AT on a claim when providing active/corrective treatment to treat acute or chronic subluxation
  • HCPCS modifier AT may not be submitted with services that meet the definition of maintenance therapy. Maintenance therapy includes services that seek to prevent disease and promote health, as well as prolong and enhance the quality of life, or maintain or prevent deterioration of a chronic condition. When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the chiropractic treatment becomes supportive rather than corrective in nature, the treatment is then considered maintenance therapy.
In order for chiropractic treatment to be covered by Medicare, the following conditions must be met:
  • The patient must have a significant health problem in the form of a neuromusculoskeletal condition necessitating treatment
  • The manipulative services must have a direct therapeutic relationship to the patient's condition
  • The manipulative services must provide reasonable expectation of recovery or improvement of function
  • The patient must have a subluxation of the spine demonstrated by X-ray or physical exam
  • HCPCS Modifier AT should not be submitted, on the same detail line, with Modifier GA. 
    • Effective for dates of service on and after November 1, 2015, if these modifiers are submitted, on the same detail line, the service will be rejected. Rejected claims must be resubmitted as new claims. 
Reference: CMS Pub. 100-02, Chapter 15, Sections 30.5 and 240 (PDF, 1.36 MB).

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