Chiropractic physicians are also known as wellness physicians. Insurance companies and patients are still jumbling through different contracts to pay the wellness physicians. At Medical Billers and Coders (MBC) we cater to the requirement of more than 70 chiropractic physicians. Each physician has different requirement based upon the demography, payer contract and patient care. Billers and Coders have to systemize the claim generation and submission according to the regulation and requirements.

“The requirements keep differencing as the patient change, so we stay flexible with the payment schedule. An update is usually done through a series of question which makes sure we don’t miss out on any criteria. The challenge is to keep the claim error-free.” informed a biller

 Here are some tips to go through for Chiropractic Billers and Coders:-

1. Preventive Evaluation and Management for New Patients

An comprehensive preventive medicine evaluation and management of an patient inculcating different  age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient;

99381: infant (age younger than 1 year)

99382: early childhood age (age 1 through 4 years)

99383: late childhood age (age 5 through 11 years)

99384: adolescent age (age 12 through 17 years)

99385: 18-39 years

99386: 40-64 years

99387: 65 years and over

2. Preventive Evaluation and Management for old Patients

Preventive medicine re-evaluation and management of an individual.

99391: infant (age younger than 1 year)

99392: early childhood age (age 1 through 4 years)

99393: late childhood age (age 5 through 11 years)

99394: adolescent age (age 12 through 17 years)

99395: 18-39 years

99396: 40-64 years

99397: 65 years and over

Codes 99381-99397 are covered by most insurance plans when performed by an MD/DO – these codes are not covered by Medicare.

3. Initial Preventive Physical Examination (IPPE) for initial chiropractic patients in Medicare

This an “Once-in-a-lifetime” covered under the Medicare benefit. This includes different lab test to check the patient health. Use HCPCS code G0402 for the initial preventive physical exam. This is a face-to-face visit and the beneficiaries can avail this during first 12 months of Medicare enrollment.

4. Medicare Annual Wellness Visits (AWV)

The AWV from Medicare include establishment of, or update to, family history and health features. The goal is health promotion and diseases prevention, however clinical lab tests are not included. AWV is not a routine medical test and Medicare won’t pay for regular physicals.  Use HCPCS code G0438 for the initial AWV. This includes a personalized prevention plan of service. This service is covered one time in the 2nd year of eligibility. Co-pay, co-insurance and deductible waived.

Use HCPCS code G0439 for the subsequent AWV. This includes a personalized prevention plan of service. This service is covered one year after the initial AWV. It does not include lab tests.  Co-pay, co-insurance and deductible waived.

5. Physical or Manipulative Therapy Performed for Maintenance rather than Restoration:

Use HCPCS code S8990, except when billing Medicare. Code S8990 can be used for chiropractic adjustments once the patient has reached maximum therapeutic benefit and has transitioned to preventive/wellness care or performance enhancing care.

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