Medical Billing Forum

Billing => Billing => Topic started by: dfranklin on February 15, 2010, 12:21:36 PM

Title: 98943
Post by: dfranklin on February 15, 2010, 12:21:36 PM
Should modifier 51 be used with 98943?  My provider who is a chiro has been billing like that.  But we receive from UPMC a not covered code telling us to resubmit with contracted CPT4, HCPC, Modifier, revenue or other code.  What does this mean? 

Thanks!
Title: Re: 98943
Post by: Pay_My_Claims on February 15, 2010, 07:17:00 PM
Billing for the CMT (98940-42) will be the same rules as before the project (that is, the CMT codes must have the -AT modifier (active therapy), or it will be rejected as "maintenance care")

Title: Re: 98943
Post by: dfranklin on February 15, 2010, 08:16:19 PM
You said 98940-989420 but does this apply to 98943 as well?
Title: Re: 98943
Post by: Michele on February 16, 2010, 07:17:28 AM
Sounds to me like the rejection is saying that 98943 is not one of their contracted codes, which indicates that they don't allow that code.  I find most carriers deny the 98943.  Have you tried calling customer service to verify? 

Michele
Title: Re: 98943
Post by: Pay_My_Claims on February 16, 2010, 09:09:43 PM
Should modifier 51 be used with 98943?  My provider who is a chiro has been billing like that.  But we receive from UPMC a not covered code telling us to resubmit with contracted CPT4, HCPC, Modifier, revenue or other code.  What does this mean? 

Thanks!

I'm no Chiro biller, but from the Chiro forum I am in (smile) It states to NOT use mod 51 with 98943 or you will not get paid!!

http://www.chiro.org/Medicare/Chiroprtactors_Guide.shtml
Title: Re: 98943
Post by: DMK on February 17, 2010, 10:40:34 AM
1. If it's Medicare they won't pay for an extremity adjustment.  Spine only. No if's, and's or but's (or wrists or elbows ha ha)

2. Be sure that there is an extremity diagnosis to justify an extremity adjustment.

3. Check the patient's policy.  Many policies only cover adjustment of the spine.

4. You shouldn't need a modifier if it's a covered benefit and you have the appropriate diagnosis.

5. The main thing I see is "not a covered code".

Dina