Department of VA-Triwest

[Chiro Billing Collect]

We have always been required to bill the VA with Medicare codes and modifiers. The past few months I have been sending in claims with the correct modifiers and they have been denied stating that the modifier combination is inconsistent. I have been entering 97140-59 GP GY, 97530 GP GY, and 99203 25 GY. The rep that I spoke with noted that she never sees the 25 billed with the 99203 or the 59 billed with the 97140 and the claims get paid. That is the exact opposite of how it should be billed in our case. I am also unsure which MCR modifiers that I should keep on (GP, GY). Anyone have insight into this?

[Michele]

Why are you appending the GY modifier?  All else looks correct to me, but I don't know why you are using the GY modifier.  The GY indicates that it is not a covered Medicare benefit, but those codes are.

[Chiro Billing Collect]

They are not covered by Medicare when billed by a chiropractor. MCR covers spinal manipulation only.

[Michele]

I didn't realize you were talking about chiro.  I should have noticed by your name.  Yes, Medicare only covers the manipulation when performed by a DC.