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Workers' compensation -- HIPAA 835 Health care claim payment/remittance advice

5221.4061 Fee adjustments for chiropractic services

Subpart 1. Multiple modalities. Maximum fees for the chiropractic modalities in the following list are determined according to the following payment schedule when more than one modality on the list is provided to the same patient on the same day. One hundred percent of the fee calculated according to the formula in part 5221.4020 for the modality with the highest relative value and 75 percent of the fee calculated according to the formula in part 5221.4020 for each additional modality. All modalities after the first modality with the highest relative value, shall be coded by adding modifier 51 to the applicable modality code.

97012	Mechanical traction therapy
97014	Electrical stimulation therapy
97016	Vasopneumatic device therapy
97018	Paraffin bath therapy
97022	Whirlpool therapy
97024	Diathermy treatment
97026	Infrared therapy
97028	Ultraviolet therapy
97032	Electrical stimulation
97033	Electric current
97034	Contrast bath therapy
97035	Ultrasound therapy
97036	Hydrotherapy
97039	Unlisted therapy service

Subp. 2. Extraspinal code. If the extraspinal code (98943) is used in conjunction with any of the spinal chiropractic manipulative treatment (CMT) codes (98940 to 98942) on the same day, the extraspinal code must be coded with CPT modifier 51. The CPT modifier 51 reduces the RVU of 98943 when used in conjunction with any of the CMT codes (98940 to 98942) on the same day by 50 percent.

Statutory Authority:  MS s 14.38; 14.386; 14.388; 175.171; 176.101; 176.135; 176.1351; 176.136; 176.231; 176.83

History:  18 SR 1472; 25 SR 1142; 35 SR 227

Posted:  Sept. 30, 2010