Wiki FQHC Chiropractic Services billed to Medicare

[pattyleber]

We are an FQHC located in Ohio and recently added Chiropractic Services. Medicare's FQHC guidelines state the Chiropractic is covered however, it does not have CPT'S 98940 or 98941 listed as "Qualified visit" attached to a "G" code.

Can an FHQC get reimbursed for Chiropractic services rendered to a Medicare patient?

Any guidance will be greatly appreciated.

Thank You!

Patty Leber

 

[smgorn]

We are an FQHC in Connecticut that is just starting to add Chiro services to our portfolio. It is my understanding that the Chiro services will only be paid if an E/M is coded on the visit. If the patient only has a manipulation and no separately billable exam was done then it would not be billable at the PPS rate.

I sent an email this morning to CMS to see if we are allowed to carve out the manipulations and bill to Part B and will share whatever info I get.

I would be interested in connecting with any other FQHCs that are currently billing for Chiro services that are willing to share their knowledge!

Thanks,
Shannon Gorneault

 

[bcarrera5]

FQHC Chiro billing

Hello i am also in Ohio and having the same issue. If anyone would like to share any new information i would greatly appreciate it.

 

[pattyleber]

FQHC Chiropractic Medicare Coverage

I received the following response from CMS FQHC Team.


Those codes are not considered stand-alone billable visits. Stand-alone billable visits are typically evaluation and management (E/M) type of services or screenings for certain preventive services. The codes that you put on your claim must reflect the services that are actually performed, so you can only use an E/M code if the E/M service was furnished. If E/M is within the chiropractor’s scope of service, then the chiropractor can furnish the E/M, and the claim would include the E/M code plus codes for any other services that were furnished. If the chiropractor only does one of those services, and there is no qualifying service furnished on the same day, then it is not a billable visit.

Listed below is the link for the qualifying visit HCPCS codes that should be used when billing encounter/visits under the PPS:

https://www.cms.gov/Medicare/Medica...Downloads/FQHC-PPS-Specific-Payment-Codes.pdf

CMS FQHC PPS Team