10 Most Common Chiropractic Billing Modifiers

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10 Most Common Chiropractic Billing
Modifiers
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10 Most Common Chiropractic Billing Modifiers

• Chiropractic Billing Modifiers
• Chiropractic care is a growing industry that is
  becoming increasingly popular among patients
  seeking non-invasive treatments for
  musculoskeletal conditions. However, billing for
  chiropractic services can be complex and
  challenging, as it requires a thorough
  understanding of the codes and modifiers used in
  medical billing. Chiropractic billing modifiers
  are codes used to provide additional information
  about the services provided, and ensure proper
  billing and reimbursement. In this article, we
  will discuss ten common chiropractic billing
  modifiers, including their descriptions, billing
  examples, and billing tips to help chiropractors
  accurately and appropriately use these modifiers
  to optimize reimbursement for their services.
• 10 Most Common Chiropractic Billing Modifiers
• 1. Modifier 59
• Description The 59 modifier is used to indicate
  that a service was distinct or separate from
  other services performed on the same day. This
  modifier is used when a provider performs a
  second service that is not typically reported
  with the first service.
• Billing Example A chiropractor provides a manual
  therapy service (97140) and a therapeutic
  exercise service (97110) during the same visit.
  The 59 modifier should be added to the second
  service (97110) to indicate that it was distinct
  from the first service.
• Billing Tip Only use the 59 modifier when the
  service is truly distinct or separate from other
  services provided on the same day. Overuse of
  this modifier can lead to billing errors and
  denials.

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10 Most Common Chiropractic Billing Modifiers

• 2. Modifier XS
• Description The XS modifier is used to indicate
  that a service was provided in a separate
  anatomical site or organ system. This modifier is
  used when multiple services are provided on
  different areas of the body.
• Billing Example A chiropractor provides a spinal
  manipulation (98940) and a therapeutic exercise
  service (97110) during the same visit. The XS
  modifier should be added to the therapeutic
  exercise service (97110) to indicate that it was
  performed on a different anatomical site than the
  spinal manipulation (98940).
• Billing Tip Use the XS modifier when services
  are provided on different anatomical sites or
  organ systems. Be sure to document the specific
  sites or systems on the claim form.
• 3. Modifier XE
• Description The XE modifier is used to indicate
  that a service was provided during a separate
  encounter. This modifier is used when multiple
  services are provided on different days.
• Billing Example A chiropractor provides a spinal
  manipulation (98940) on Monday and a therapeutic
  exercise service (97110) on Wednesday. The XE
  modifier should be added to the therapeutic
  exercise service (97110) to indicate that it was
  performed during a separate encounter.
• Billing Tip Use the XE modifier when services
  are provided on different days. Be sure to
  document the dates of service on the claim form.

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10 Most Common Chiropractic Billing Modifiers

• 4. Modifier XU
• Description The XU modifier is used to indicate
  that a service does not have a specific,
  established code. This modifier is used when a
  service is provided that does not have a specific
  billing code.
• Billing Example A chiropractor provides a
  service that is not covered by a specific billing
  code. The XU modifier should be added to the
  claim form to indicate that the service does not
  have a specific, established code.
• Billing Tip Only use the XU modifier when there
  is not a specific billing code available for the
  service provided. Be sure to document the
  specific service on the claim form.
• 5. Modifier XP
• Description The XP modifier is used to indicate
  that a service was provided by a physician
  assistant, nurse practitioner, or clinical nurse
  specialist. This modifier is used when the
  service is provided by a non-physician
  practitioner.
• Billing Example A chiropractor employs a
  physician assistant who provides a spinal
  manipulation (98940). The XP modifier should be
  added to the claim form to indicate that the
  service was provided by a non-physician
  practitioner.
• Billing Tip Only use the XP modifier when the
  service is provided by a non-physician
  practitioner. Be sure to document the specific
  practitioner on the claim form.
• 6. Modifier AT
• Description The AT modifier is used to indicate
  that an active treatment was provided during the
  visit. This modifier is used when a therapeutic
  procedure is performed that requires the skills
  of a licensed therapist.

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10 Most Common Chiropractic Billing Modifiers

• Billing Example A chiropractor provides a manual
  therapy service (97140) that requires the skills
  of a licensed therapist. The AT modifier should
  be added to the claim form to indicate that
  active treatment was provided during the visit.
• Billing Tip Only use the AT modifier when an
  active therapeutic procedure is performed that
  requires the skills of a licensed therapist. Be
  sure to document the specific therapy provided on
  the claim form.
• 7. Modifier GA
• Description The GA modifier is used to indicate
  that a service was provided, but is not covered
  by the patients insurance plan. This modifier is
  used when a service is provided that is not
  covered by the patients insurance plan, but is
  still necessary for the patients care.
• Billing Example A chiropractor provides a
  service that is not covered by the patients
  insurance plan, but is still necessary for the
  patients care. The GA modifier should be added
  to the claim form to indicate that the service
  was provided, but is not covered by insurance.
• Billing Tip Only use the GA modifier when a
  service is provided that is not covered by the
  patients insurance plan, but is still necessary
  for the patients care. Be sure to document the
  specific service provided on the claim form.
• 8. Modifier GY
• Description The GY modifier is used to indicate
  that a service is statutorily excluded or does
  not meet medical necessity criteria. This
  modifier is used when a service is provided that
  is excluded or not medically necessary, but is
  still provided.

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10 Most Common Chiropractic Billing Modifiers

• Billing Example A chiropractor provides a
  service that is excluded or not medically
  necessary, but is still provided. The GY modifier
  should be added to the claim form to indicate
  that the service does not meet medical necessity
  criteria.
• Billing Tip Only use the GY modifier when a
  service is excluded or not medically necessary,
  but is still provided. Be sure to document the
  reason for providing the service on the claim
  form.
• 9. Modifier GZ
• Description The GZ modifier is used to indicate
  that a service is expected to be denied as not
  reasonable or necessary. This modifier is used
  when a service is provided that is not expected
  to be covered by insurance.
• Billing Example A chiropractor provides a
  service that is not expected to be covered by
  insurance. The GZ modifier should be added to the
  claim form to indicate that the service is
  expected to be denied as not reasonable or
  necessary.
• Billing Tip Only use the GZ modifier when a
  service is not expected to be covered by
  insurance. Be sure to document the reason for
  providing the service on the claim form.
• 10. Modifier 25
• Description The 25 modifier is used to indicate
  that a significant, separately identifiable
  evaluation and management (E/M) service was
  performed on the same day as a procedure. This
  modifier is used when a significant E/M service
  is provided on the same day as a procedure.

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10 Most Common Chiropractic Billing Modifiers

• Billing Example A chiropractor provides a
  significant E/M service (99213) and a spinal
  manipulation (98940) during the same visit. The
  25 modifier should be added to the E/M service
  (99213) to indicate that it was significant and
  separately identifiable from the procedure.
• Billing Tip Only use the 25 modifier when a
  significant, separately identifiable E/M service
  is provided on the same day as a procedure. Be
  sure to document the reason for the E/M service
  on the claim form.
• Chiropractic billing modifiers provide additional
  information about the services provided to ensure
  proper billing and reimbursement. It is important
  to use these modifiers accurately and
  appropriately to avoid billing errors and
  denials. By understanding the descriptions and
  billing examples of these common chiropractic
  billing modifiers, chiropractors can improve
  their billing practices and optimize
  reimbursement for their services.
• Legion Healthcare Solutions is a reliable
  chiropractic billing company that offers
  comprehensive billing services to chiropractors.
  We understand the complexities of chiropractic
  billing and are committed to providing
  personalized solutions that meet the specific
  needs of each client. Our team of billing
  specialists are knowledgeable about the latest
  coding regulations and can ensure that claims are
  processed promptly and accurately. By partnering
  with Legion Healthcare Solutions, chiropractors
  can focus on providing quality care to their
  patients, while leaving their billing needs in
  the hands of a trusted and reliable partner. To
  know more aboutour chiropractic billing services,
  contact us at 727-475-1834 or email us at
  info_at_legionhealthcaresolutions.com

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