Coding > Coding
98941 AT-Medicare Acute & 98941 GA-Medicare (ABN signed)
dfranklin:
I recently took on a new client and he provided me with one of his superills.
• On his superbill he has 98941 AT-Medicare Acute and the next line has 98941 GA-Medicare (ABN signed) do you know what these mean and the differences?
I believe he is referring to Medicare of GA Advanced Beneficiary Notification (Meaning he has let the patient know these charges may not be covered and they are responsible) but I am guessing...and I have no idea on teh 98941 AT-Medicare Acute...?? Anyone know?
Thanks!
Don
jcbilling:
Medicare does not cover chiropractic adjustments when used for maintenance care - only for acute injury. The AT modifier indicates that is was for an acute or chronic injury.
I'm not sure which Medicare contractor you are billing to, but this cut and paste below is from the chiropractic manual for Trailblazer Health, LLC - the Medicare contractor I bill to.
There are three categories of conditions:
• Acute – A patient’s condition is considered to be acute when the patient is being treated for a new illness or injury. The result of chiropractic treatment is expected to be an improvement in, arrest or retardation of the patient’s condition.
• Chronic – A patient’s condition is considered chronic when it is not expected to completely significantly improve or be resolved with further treatment (as is the case with an acute condition), but where continued therapy can be expected to result in some functional improvement. Once the clinical status has remained stable for a given condition without expectation of additional functional improvement, further manipulation treatment is considered maintenance therapy and is not covered.
• Maintenance Therapy – A treatment plan that seeks to prevent disease, promote health and prolong and enhance the quality of life, or maintain or prevent deterioration of a chronic condition is not a Medicare benefit. Once the maximum clinical benefit has been achieved for a given condition, ongoing maintenance therapy is not considered to be medically reasonable or necessary and is not payable under the Medicare program. An Advance Beneficiary Notice (ABN) is required.
BILLING FOR ACTIVE/CORRECTIVE TREATMENT
Chiropractic services that provide acute or chronic active/corrective treatment must be billed with the AT modifier. However, the presence of the AT modifier may not in all instances indicate the service is reasonable and necessary.
If codes 98940–98942 are billed without the AT modifier, the treatment will be considered maintenance therapy and will not be covered.
BILLING FOR MAINTENANCE THERAPY
Maintenance therapy is not a Medicare benefit. Maintenance therapy is defined as a treatment plan that seeks to prevent disease, promote health and prolong and enhance the quality of life or therapy, which is performed to maintain or prevent deterioration of a chronic condition. Once the maximum therapeutic benefit has been achieved for a given condition, ongoing maintenance therapy is not covered under the Medicare program. Chiropractic maintenance therapy is not medically reasonable or necessary and is not payable under the Medicare program.
The AT modifier must not be placed on the claim when maintenance therapy has been provided. Claims without the AT Modifer are ocnsidered mainenance therapy and will be non-covered.
The GA modifier indicates that there is an ABN on file, thus allowing the patient to be billed if Medicare does not cover the treatment.
Hope this helps!
~ Charity
dfranklin:
This helped a TON!!! Thank you so much.
Don
jcbilling:
No problem - have a good day!
~ Charity
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