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As part of legislation overhauling the 38-year old Medicare program
-- passed by the House of Representatives on November 22nd and the Senate on November 24th, 2003 - President Bush authorized a two-year pilot project designed to test expanded access to chiropractic services for America's seniors. This portion of our website is designed to make sure that interested doctors and other parties have access to all the details about the Medicare Chiropractic Demonstration Project, including information about related ACA seminars and the ACA legislative action that helped create this unprecedented opportunity.
To subscribe to the ACA Demo e-Alert, a periodic newsletter that contains updates on the project for individuals within the chiropractic demonstration project areas, click here.
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Annual Update to Therapy Code List (Change Request 4226)
Certain Codes that May Affect DCs Participating in the Demo:
- Code 97504 is replaced with code 97760
- Code 97703 is replaced with code 97762
- Code 97020 (microwave) is deleted and combined with code 97024
- Code 95858 is deleted
- Codes 97039 & 97139 are no longer subject to the fee schedule pricing but based on carrier recommendation
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Centers for Medicare and Medicaid Services
Medicare Learning Network (MLN) Matters Articles are provider education tools created by CMS. These are three such articles which deal with the demonstration project. These articles have the latest details of the demonstration project, including CPT and ICD9 codes, information for radiologists and clinical laboratories, billing instructions, affected areas, and other relevant information.
According to its website, 'the Federal Register is the official daily publication for rules, proposed rules, and notices of Federal agencies and organizations, as well as executive orders and other presidential documents.' This particular link will take you to the Federal Register notice about the chiropractic demonstration project.
The ACA has developed a draft letter for DCs in the demo areas to send to their local newspapers to raise awareness of the demo project. Please feel free to take this letter, make it your own, and spread the word about chiropractic!
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“Incident to” is a phrase that describes the delivery of certain services through an individual other than the actual healthcare practitioner (e.g., electrical stimulation performed by a chiropractic assistant ‘incident to’ a doctor of chiropractic). The current discussion about the ‘incident to’ regulations is related to standards surrounding the delivery of physical medicine services.
As of July 25, 2005, for therapy to be reimbursed under the Medicare Demonstration Project, the therapy must be delivered by either a physician or someone that qualifies as a “therapist” (e.g., a physical therapist).Click here for general information on “incident to.”
How does this affect you if you’re a DC in the demonstration project?
You have some options:
- If your assistant meets the qualifications outlined in the “incident to” regulation, you can have them perform the service and it will be reimbursable.
- You can perform the service yourself and it will be reimbursable.
- For some or all of the time, you can have an individual who does not meet the qualifications outlined in the “incident to” regulation perform the service (e.g., a chiropractic assistant), but it will not be reimbursable. In this case, you will need to bill the service(s) on your “non-demo” claim with a GY modifier (in addition to the –GP always required on physical medicine services).
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 ACA Legislative Action Center |
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The ACA Demo e-Alert is a newsletter designed for doctors and billing staff practicing in the areas of the Medicare chiropractic demonstration project. This e-Alert will go out periodically to help individuals in these areas understand the regulations and billing procedures, as well as communicate the latest news from Centers for Medicare & Medicaid Services (CMS). ACA discusses details of the demonstration project regularly with CMS and other entities, and wants to ensure that the people on the frontline of this important initiative have access to all the information they need.
Email sign-up form
Please enter the following information to join the email list:
*Click here to see a list of zip codes linked to the demo project. (You must be within one of these zip codes in order to take part in the demonstration project and subscribe to this e-alert. If you are a representative of a state association or a CCAC representative from another area who is interested in receiving this e-alert, please email Jaime Mulligan, ACA Legal Affairs Manager, at jmulligan@acatoday.org) | | |
