Chiropractors Billing Medicare for Therapy Services

Chiropractors in the Medicare fee-for-service realm are only allowed to be considered for spinal manipulation via submission of CPT codes 98940‒98942. Medicare pays for these services when they are reasonable and medically necessary and meet all coverage guidelines. 

Chiropractors do also perform additional services that Medicare does not consider for coverage. Any service outside of spinal manipulation is denied by Medicare as noncovered. Therapy services provided by a chiropractor, although noncovered must be submitted according to therapy guidelines along with one of the therapy modifiers. CMS Internet-Only-Manual, Publication 100-4, Medicare Claims Processing Manual, Chapter 5, Section 10.4 (B) indicates, “claims containing any of the ‘always therapy’ codes must have one of the therapy modifiers appended (GN, GO, GP). Contractors shall return claims for ‘always therapy’ codes when they do not contain appropriate therapy modifiers for the applicable HCPCS codes.” Therefore, if a chiropractor submits an “always therapy” code they must submit the appropriate physical therapy modifier with the code in order for the service to deny as noncovered. If the modifier is not appended the service will reject for not containing a valid modifier.

To determine which codes are considered “always therapy” services you will need to review the Annual Therapy Update provided by CMS that establishes this list of codes that are applicable.

Posted 3/5/2020