Medicare Coding FAQ 

Q.What will the Medicare deductible be for 2008?
A. The Medicare deductible will be $135.00 for Part B claims. Make sure Senior patients didn't have other services.

Q: Does Medicare cover wellness or preventative visits?
A: No. It's up to the doctor to make certain that the visit is documented as a wellness or preventative visit and you will need to submit it to Medicare, if you have signed an ABN.  You will want to use the GA modifier and note the patient's chart that it is a maintenace visit.

Q: When billing a 98940 to Medicare, do I charge/submit our normal fee and they only consider 23.09 or do I have to submit 23.09 not our regular fee?
A: That depends on whether you are participating or not. If you are non-par, you may only bill the limiting charge. If you are participating, you can submit your regular fee, then write off the difference and charge the patient when you get paid for the 20% of allowable.
Then the patient is reimbursed by Medicare $18.47 correct? And Medicare makes the payment to the patient, not us - correct?
That would only be if you're billing only one of the codes, which I hope is not what you're doing. And then only if you're non-participating. Sounds like you are non-par....I don't know the numbers for your area. If you got a letter from Noridian in December, it will tell you the limiting charge. The pt. will then be paid 80% of the non-par allowance, and they can get 20% from their secondary insurance. The difference between the non-par allowance and the limiting charge is never recouped by the patient. It's their "penalty" for seeing a non-par provider.

Q: Medicare only covers a 98940 - any other charges the patient is responsible for in full, correct?
A: No, they cover 98940, 98941, and 98942. Everything else is considered non-covered and the pt. can be billed for it.

Q: If a patient has Medicare we have to bill it as Medicare, they cannot be considered a cash/no insurance case right?
A: Correct...there is a new ABN coming out this year that may allow the pt. to opt out of having Medicare billed for maintenance care, but no word yet.

Q. Is their a visit limit on how many Medicare visits one is allowed?
A: No, as long as it's reasonable and customary.

Q: Do Medicare claims need to include Subluxation Levels and Patient Symptoms? How about Date of X-Rays and Number of Visits? If not, just what information am I required to provide on a claim?
A: Medicare varies from state to state, for each carrier tends to make their own rules. However, most all states require that you use approved diagnosis codes, such as the primary being a subluxation/segmental dysfunction code in the 739.X series, then the secondary code to that being something from one of their approved lists of codes that is a condition related to that level of subluxation. You should have that for each spinal area you are treating, even if you must document them in the file as there is not much room in the 1500 form's box 21. Many carriers would like the x-ray date in the local use line 19 on the 1500 form, but some don't require it. As for the visit number, that is not something I've ever seen requested. I'd encourage you to check out your carrier's Local Medicare Review Policy by going to this link: http://www.cms.hhs.gov/mcd/search.asp?from2=search1.asp and when you get to the keyword, use "chiropractic" and select your state. This should help you with the most recent information from your carrier. I'd also recommend contacting your state's Carrier Advisory Committee member, who is appointed to sit on the carrier's Medicare Advisory Committee to represent Chiropractic. They can certainly help you. Check with your local state association for the name or call ACA and see if they can help you.