Can I use an ABN (Advance Beneficiary Notice of Noncoverage) for chiropractic services?

Answer
An Advance Beneficiary Notice (ABN) should only be issued if the provider believes that Medicare may not cover a service because it is not medically reasonable and necessary.

An ABN cannot be issued for services that are being billed with the HCPCS modifier AT. The AT HCPCS modifier serves as an indication that the chiropractor is providing active/corrective treatment to address an acute or chronic subluxation; the modifier may not be submitted when services meet the definition of maintenance therapy.

Additionally, an ABN cannot be issued solely because documentation may not meet Medicare’s guidelines. Without all required documentation, our clinical reviewers cannot establish whether the service rendered was medically necessary. If the service is not documented properly, the claim will deny as contractual obligation, and the beneficiary cannot be billed.

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