Medicare Chiropractic Limiting Fee?

[Christy]

Can anyone tell me or direct me to a place where I can find the non-par Medicare limiting fees for chiropractic care (98940 and 98941)?

This would be for patients who signed an ABN are are receiving maintenance care that is non covered by Medicare.

thanks!!!!

[RichardP]

Christy, you might read thru the first page of the first link and Misinformation #5 at bottom right of second page of the second link provided below.

The first link will show you how to calculate the number you are asking for.

But regarding the ABN:  you said ... who signed an ABN and are receiving maintenance care that is non covered by Medicare.  At the top left of Page 3 of the second link, underneath Option 3, CMS makes this statement:

An ABN is issued each time a patient receives a Medicare covered service that the provider believes might be considered not medically reasonable and necessary and thus not payable by Medicare.

If you were using that phrase correctly in your post - receiving maintenance care that is non covered by Medicare - then no ABN is required.

Edit:  We must distinguish between:

 1.  A service or procedure that Medicare covers, but might choose to not pay;
 2.  A service or procedure that Medicare does not cover, so no payment is expected.

Only the first situation requires an ABN.

http://www.acatoday.org/content_css.cfm?CID=2032

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Chiropractors_fact_sheet.pdf

[Christy]

thanks Richard- yes it is scenario #1.

Medicare covers chiropractic adjustments for active/corrective treatment.
they can deny payment at any time if they determine that the care has become maintenance, rather than acute/corrective.

thus, the provider has patients sign an ABN in the case of denial.