Health Information Management

Q/A: Billing for x-rays ordered by a chiropractor

APCs Insider, March 18, 2011

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Q: A local chiropractor frequently sends patients to our hospital outpatient radiology department for x-rays. May we bill Medicare for these services?

A: Medicare covers some chiropractic services. However, the Medicare Benefit Policy Manual, Chapter 15 section 30.5, states:

All other services furnished or ordered by chiropractors are not covered. If a chiropractor orders, takes, or interprets an x-ray or other diagnostic procedure to demonstrate a subluxation of the spine, the x-ray can be used for documentation. However, there is no coverage or payment for these services or for any other diagnostic or therapeutic service ordered or furnished by the chiropractor.

Therefore, ask the patient sign an Advance Beneficiary Notice prior to the service and report the service with modifier –GA. This modifier indicates that the provider or supplier has provided an Advance Beneficiary Notice (ABN) to the patient.

Editor’s note: Andrea Clark, RHIA, CCS, CPCH, president of Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.



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