Reminder: Chiropractic changes coming Oct. 1, 2018

As a reminder, Priority Health is updating their billing requirements for chiropractic services. In order to accurately identify chiropractic services that are covered according to our Rehabilitative & Habilitative Medicine Services medical policy, until July 1, 2018 the AT (acute treatment) modifier should be appended to chiropractic CPT codes 98940, 98941, 98942 for all products. This requirement has already been in effect for Medicare claims, and we are now expanding it to all products.

Chiropractic rider coverage on some plans starting Oct. 1

Starting Oct. 1, some large groups have opted to purchase a chiropractic rider that covers chiropractic maintenance services.  Providers need to check a patient's benefits before assuming maintenance services are not covered.  To help make benefit determination easier, we have made enhancements to the member inquiry tool. From the member inquiry tool, when a member has a chiropractic rider, it will appear under Chiropractic. When they have a visit limit that's combined with PT and OT visits, it will appear under Rehabilitative Medicine Services.

AT modifier update

Starting Oct. 1, the AT modifier must be used on claims when providing active/corrective treatment to treat acute or chronic subluxation.

The AT modifier must be documented accordance with the Centers for Medicare & Medicaid Services Medicare Benefit Policy Manual, Chapter 15, Section 240, when submitting claims.

Claims for CPT codes 98940, 98941, 98942 that are not appended by the AT modifier will be interpreted as "maintenance" or "custodial" services and will be denied for non-coverage per our policy.  For past news items on this change, navigate here.