Chiropractic CE: Navigate the New Insurance Modifier Maze with CCEDseminars Posted on Sep 17, 2023

Avoid Denials this Year: Navigating the New Insurance Modifier Maze

Image of doctor documenting after chiropractic online ce courseCCEDseminars | The definitive Destination For Chiropractic Online CEChiropractic professionals know that navigating the insurance billing landscape can be quite a daunting task, especially with the continuous changes in billing rules and procedures. In 2023, the chiropractic community faces a new challenge — the enforcement of modifiers in the insurance billing process. Let us delve deep into understanding and effectively utilizing these modifiers in your chiropractic practice.

Understanding the Importance of Modifiers

Modifiers offer additional information regarding a service or procedure provided by a healthcare provider, further contextualizing a CPT code without altering its definition. Using the correct modifiers not only helps in providing the necessary information but also aids in avoiding claim denials.

A Closer Look at Medicare Modifiers

Medicare, which often sets the guideline for others, has simplified its approach to modifiers for chiropractic adjustment CPT codes such as 98940, 98941, and 98942. Understanding the correct usage of the AT, GA, and GZ modifiers can prove to be crucial in facilitating successful claims.

Physical Medicine Codes and Their Modifiers

Physical medicine codes require specific modifiers, including the GP and GY modifiers, to indicate the nature of the service provided correctly. It is imperative to understand when to use additional modifiers such as 59 or XS to signify distinct services that should not be bundled with the adjustment.

X-Ray Codes and Modifiers

When billing for x-ray services, utilizing the GY modifier alongside other necessary modifiers is essential to indicate the exact services rendered correctly and avoid denial of claims. Understanding the distinctions between modifiers 26 and TC is crucial to bill appropriately for these services.

Insights into General Insurance, WC, and PI Modifiers

General insurance, along with Workers' Compensation (WC) and Personal Injury (PI) claims, also follow the modifier guidelines, albeit with slight differences from Medicare. Learn the accurate usage of GP, 59, or XS modifiers, and when to use code-specific modifiers to streamline the billing process.

Humana’s Unique Requirements

Humana has its unique set of requirements when it comes to utilizing modifiers, emphasizing the necessity to denote whether a service was habilitative or rehabilitative. Knowing when to use the 96 or 97 modifiers is crucial in dealing with Humana insurance claims.

Navigating the New Landscape with CCEDseminars

As you steer through the constantly evolving landscape of chiropractic billing, CCEDSeminars stands with you, offering insights and education to help you avoid denials and foster a smoother billing process. Explore with Dr. Monte Horne as he expounds on these new guidelines, helping you stay ahead in the chiropractic CE landscape. Click HERE to learn more!

Get equipped to face the new challenges head-on with the 

expert guidance from CCEDSeminars.

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