Last Friday, President Trump signed into law the “omnibus” spending bill, known as the Consolidated Appropriations Act of 2018. One provision of the new law calls for the U.S. Department of Veterans Affairs (VA) to expand the availability of chiropractic services at no fewer than two medical centers or clinics in each Veterans Integrated Service Network (VISN) by no later than Dec. 31, 2019, and at no fewer than 50 percent of all medical centers in each VISN by no later than Dec. 31, 2021.
The measure also, for the first time, codifies and broadens chiropractic services in the VA to include services provided by chiropractors under the “Preventive Health Services” and “Medical” categories – in addition to existing coverage under “Rehabilitative Services” – placing chiropractors in service categories previously closed to them.
Expansion of access to drug-free chiropractic care among our Veterans remains a critical issue, as more and more Vets returning from Iraq and Afghanistan and suffering from musculoskeletal issues are demanding pain management alternatives to highly dangerous and addictive opioids.
Priority Health has announced that they have postponed the date that they will require the AT (acute treatment) modifier to be appended to chiropractic CPT® codes 98940, 98941, and 98942 until July 1, 2018. This was originally scheduled for March 1. This requirement applies to Priority’s entire product line.
According to Priority, effective July 1, 2018:
MAC Insurance Director Carl Alden cautions that the mere presence of the AT modifier may not in all instances show that the service is reasonable and medically necessary, and it is imperative that your documentation supports active/corrective treatment. For more information regarding proper documentation for initial and subsequent visits, a good place to start is the Medicare LCD, which can be found on the MAC website’s home page, www.chiromi.com. Just scroll down to the “Important Members Only Resources” and click on “Medicare LCD Effective 2-2018 [NEW].”
Additional information can be found in the Medicare Benefit Policy Manual, Chapter 15, Section 240.1.3 (Necessity for Treatment), available online here.
For non-Medicare maintenance care patients, Priority Health has a form equivalent to Medicare’s ABN Form, the “Patient Acknowledgement of Financial Liability.” For Medicare beneficiaries, the “Notice of Medicare Non-Coverage” form should be used. These forms can be downloaded from the Priority Health website.