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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

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