We currently require the use of modifier “AT” (acute or active treatment) when billing current procedural terminology (CPT) codes 98940, 98941 and 98942 for chiropractic services provided to our Medicare Advantage members, pursuant to the Centers for Medicare & Medicaid Services (CMS) Local Coverage Determination policy (L33613), titled “Chiropractic Services.”
Effective January 1, 2020, this requirement will pertain to all of our products and lines of business. Claims submitted with CPT codes 98940, 98941 and 98942 that do not include the “AT” modifier for dates of service on or after January 1 will be denied.
For additional information, please review our Chiropractic Care medical policy, available on our website at Provider.Excellusbcbs.com/policies/medical. As stated in the medical policy, “Maintenance care begins when the therapeutic goals of a treatment plan have been achieved or when no additional functional progress is apparent or expected to occur. Maintenance care is considered not medically necessary.”
Please keep in mind that all chiropractic care is subject to retrospective utilization review to determine
medical necessity. Coverage for services determined to be not medically necessary will be denied.
If you have any questions about this information, please contact your Provider Relations representative.
Thank you for the quality care and service that you provide to our valued members.