Re: Re: Manual Therapy=CMT?

May 31, 2006

I had a similar question...I had called for benefits

for a patient with Regence BCBS of Oregon and there is

no chiropractic benefit on his particular policy. I

proceeded to ask if physical therapy(ex:97140, 97124,

97012, 97035, 97014, etc.) was covered and was told it

was if it was in the scope of license which I said PT

was in the scope of the Oregon chiropractic license.

I was then told after the benefits person consulted

with someone else there that PT was covered under the

rehab care benefit if I was dual licensed as a DC and

a PT. This to me sounds discriminatory. Are we not

licensed as a DC to perform PT and should this be

covered by insurance if PT is a service that they

typically cover?

On another issue...is anyone else having trouble with

Progressive not paying for massage therapy(97124) when

performed with an adjustment? I do mean a 15 minute

billable 97124 and not a quicky 2 minute massage.

Their explaination of payment suggests that 97124 is

included with manipulation codes (ex:98941) They use a

code X11. They claim that this is AMA. They

apparently do pay 97124 on the same day if not

performed/billed by the DC. I have read in the 2004

ChiroCode DeskBook on pages 99C-100C that this

practice of not paying 97124 with 98940-98942 is

considered bundling.

What can we do to end these ridiculous/discriminatory

practices?

Brad Pfeiffer, DC

Bend, OR

--- spbkchiro97132 <spbkchiro@...> wrote:

> Insurance contracts require the use of the CPT codes

> by providers

> (copyright of the good old AMA) and if we chiros

> CHOOSE to use these

> far-from-perfect codes in our

> notes/communications/billings, we are

> agreeing to the terms of use by default. One of the

> terms of use is

> that we are to use the code that most accurately

> describes the service

> rendered.

>

> >

> > I have a patient who has exhausted her CMT limit

> for the year (a

> mind numbing 8 visits), but she still has physical

> therapy benefits.

> So I am wondering if I can bill manual therapy for

> CMT.

> >

> > Insurance companies have bundled these codes

> because they are

> similar in nature, so I would assume that I could

> use the MT code in

> place of the CMT code.

> >

> > Thoughts?

> >

>

__________________________________________________

May 31, 2006

Hi Brad,

I have received reimbursement from Progressive for massage only by attaching the -59 modifier to the 97124 code and of course including the details concerning the massage in my chart notes.

Holzapfel, DCAlbany-- Brad Pfeiffer <hollyandbrad@...> wrote:I had a similar question...I had called for benefitsfor a patient with Regence BCBS of Oregon and there isno chiropractic benefit on his particular policy. Iproceeded to ask if physical therapy(ex:97140, 97124,97012, 97035, 97014, etc.) was covered and was told itwas if it was in the scope of license which I said PTwas in the scope of the Oregon chiropractic license. I was then told after the benefits person consultedwith someone else there that PT was covered under therehab care benefit if I was dual licensed as a DC anda PT. This to me sounds discriminatory. Are we notlicensed as a DC to perform PT and should this becovered by insurance if PT is a service that theytypically cover?On another issue...is anyone else having trouble withProgressive not paying for massage therapy(97124) whenperformed with an adjustment? I do mean a 15 minutebillable 97124 and not a quicky 2 minute massage. Their explaination of payment suggests that 97124 isincluded with manipulation codes (ex:98941) They use acode X11. They claim that this is AMA. Theyapparently do pay 97124 on the same day if notperformed/billed by the DC. I have read in the 2004ChiroCode DeskBook on pages 99C-100C that thispractice of not paying 97124 with 98940-98942 isconsidered bundling. What can we do to end these ridiculous/discriminatorypractices?Brad Pfeiffer, DCBend, OR--- spbkchiro97132 <spbkchiro@...> wrote:> Insurance contracts require the use of the CPT codes> by providers> (copyright of the good old AMA) and if we chiros> CHOOSE to use these> far-from-perfect codes in our> notes/communications/billings, we are> agreeing to the terms of use by default. One of the> terms of use is> that we are to use the code that most accurately> describes the service> rendered.> > > > >> > > > I have a patient who has exhausted her CMT limit> for the year (a> mind numbing 8 visits), but she still has physical> therapy benefits. > So I am wondering if I can bill manual therapy for> CMT. > > > > Insurance companies have bundled these codes> because they are> similar in nature, so I would assume that I could> use the MT code in> place of the CMT code. > > > > Thoughts?> >> > > > > __________________________________________________

May 31, 2006

Hi ...You must have been dealing with someone at

Progressive other than I am...I have also included the

modifier-59 as well as chart notes which specify the

time spent on massage...but thanks for the info. Maybe

if the claim handler hears that Progressive has

recently paid 97124-59 along with 98940-98942 he will

do the right thing and process to pay.

Brad Pfeiffer, DC

Bend, OR

--- " kjholzdc@... " <kjholzdc@...> wrote:

> Hi Brad,

> I have received reimbursement from Progressive for

> massage only by attaching the -59 modifier to the

> 97124 code and of course including the details

> concerning the massage in my chart notes.

> Holzapfel, DC

> Albany

>

> -- Brad Pfeiffer <hollyandbrad@...> wrote:

> I had a similar question...I had called for benefits

> for a patient with Regence BCBS of Oregon and there

> is

> no chiropractic benefit on his particular policy. I

> proceeded to ask if physical therapy(ex:97140,

> 97124,

> 97012, 97035, 97014, etc.) was covered and was told

> it

> was if it was in the scope of license which I said

> PT

> was in the scope of the Oregon chiropractic license.

>

> I was then told after the benefits person consulted

> with someone else there that PT was covered under

> the

> rehab care benefit if I was dual licensed as a DC

> and

> a PT. This to me sounds discriminatory. Are we not

> licensed as a DC to perform PT and should this be

> covered by insurance if PT is a service that they

> typically cover?

>

> On another issue...is anyone else having trouble

> with

> Progressive not paying for massage therapy(97124)

> when

> performed with an adjustment? I do mean a 15 minute

> billable 97124 and not a quicky 2 minute massage.

> Their explaination of payment suggests that 97124 is

> included with manipulation codes (ex:98941) They use

> a

> code X11. They claim that this is AMA. They

> apparently do pay 97124 on the same day if not

> performed/billed by the DC. I have read in the 2004

> ChiroCode DeskBook on pages 99C-100C that this

> practice of not paying 97124 with 98940-98942 is

> considered bundling.

> What can we do to end these

> ridiculous/discriminatory

> practices?

>

> Brad Pfeiffer, DC

> Bend, OR

>

> --- spbkchiro97132 <spbkchiro@...> wrote:

>

> > Insurance contracts require the use of the CPT

> codes

> > by providers

> > (copyright of the good old AMA) and if we chiros

> > CHOOSE to use these

> > far-from-perfect codes in our

> > notes/communications/billings, we are

> > agreeing to the terms of use by default. One of

> the

> > terms of use is

> > that we are to use the code that most accurately

> > describes the service

> > rendered.

> >

> > >

> > > I have a patient who has exhausted her CMT limit

> > for the year (a

> > mind numbing 8 visits), but she still has physical

> > therapy benefits.

> > So I am wondering if I can bill manual therapy for

> > CMT.

> > >

> > > Insurance companies have bundled these codes

> > because they are

> > similar in nature, so I would assume that I could

> > use the MT code in

> > place of the CMT code.

> > >

> > > Thoughts?

> > >

> >

>

> __________________________________________________

>

June 1, 2006

I too have not had a problem with this and (gulp) I don't even bother with

the modifier unless it's a 97140 on a separate area.

Dr. ph Medlin D.C.

Spine Tree Chiropractic