Maintenance therapy and corrective treatment billing

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 modifier are considered maintenance therapy and will be non-covered.

Since maintenance therapy is not a Medicare benefit and is considered not medically necessary, the beneficiary will need to sign an ABN form. Complete instructions regarding the ABN may be found on the TrailBlazerSM Web site at:

http://www.trailblazerhealth.com/Publications/Training Manual/abn.pdf