Online Chiropractic CE Guide: Navigating New Insurance Modifier Maze | CCEDSeminars Posted on Sep 18, 2023

Online Chiropractic CE: Navigating the New Insurance Modifier Maze

Image of EHR on our chiro online blog postCCEDseminars | Your Premiere Source of Chiro Online Learning!Understanding Modifiers in Chiropractic Billing

If you are involved in the chiropractic profession, understanding the ins and outs of Online Chiropractic CE is essential. Recent changes have brought about a series of challenges, notably an increase in denied claims due to “missing” or “invalid modifiers”. The landscape is evolving, and keeping up with the changes in billing practices is crucial to avoid unwanted surprises.

Join us at CCEDseminars as we delve deep into the complex world of insurance modifiers and provide you with insights to navigate the maze effectively and efficiently.

Medicare Modifiers: The Foundation of Chiropractic Billing

Medicare often sets the guidelines in healthcare billing, including chiropractic services. The commonly used modifiers for chiropractic adjustment CPT codes (98940, 98941, and 98942) are:

  • AT – Acute Care: This modifier signifies medical necessity, a requirement for Medicare to cover a service.
  • GA: Used when an Advance Beneficiary Notice (ABN) has been given, allowing patient charging if Medicare denies the claim due to perceived lack of treatment progress.
  • GZ: Indicates no ABN has been given, hence no charges can be transferred to the patient.

Understanding the correct utilization of modifiers can save your practice from denials and foster a smoother billing process.

Physical Medicine Codes: A Closer Look

Physical medicine codes such as 97530 and 97012 need to always bear the GP modifier. Additionally, the GY modifier must be included to denote non-covered services by Medicare. Correct coding is vital to meet Medicare’s requirements and secure rightful payments.

Modifiers in General Insurance, WC, and PI

Different payers have varied requirements, but generally, the GY modifier isn't used outside of Medicare. Understanding the distinctions can assist in selecting the appropriate modifiers and averting denials.

Humana: Setting Distinct Requirements

Humana adopts a distinct approach, necessitating the use of either the 96 or 97 modifiers to state whether a service is habilitative or rehabilitative. It is essential to be well-acquainted with the specific requirements to ensure successful billing.

Your EHR Billing Software: An Essential Tool

To facilitate the billing process, ensure that your EHR billing software can automatically assign the correct modifiers using a well-defined algorithm, reducing the likelihood of avoidable denials.


With the continuous evolution in billing practices, staying abreast with the latest information in Online Chiropractic CE is more crucial than ever. At CCEDseminars, we strive to empower you with the knowledge to navigate the insurance modifier maze successfully, avoiding unnecessary claim denials and fostering a thriving practice. Try our FREE course "Coding And Documentation 201"!

Don’t find yourself in a tangle of denied claims. Equip yourself with the understanding and tools necessary to navigate the insurance modifier maze confidently. Visit CCEDSeminars to stay updated and to learn more.

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