How many of us went to a chiropractor only once? How often did you go when you first initiated chiropractic treatment vs. months later? Do you know if you are undergoing active or maintenance treatment? Active treatment basically means a condition is being treated that will improve within a reasonable or expected period of time. Maintenance treatment is meant to “prevent disease, promote health and prolong and enhance the quality of life, or maintain or prevent deterioration of a chronic condition.”1

Billing for Active Treatment

According to CMS, the -AT modifier should be included on Current Procedural Terminology (CPT) codes 98940-98942 (Chiropractic manipulative treatment -CMT codes) and should ONLY be included for services treating acute or chronic conditions. If providers are performing maintenance therapy, then the -AT modifier should not be used as these services are not covered by Medicare and most commercial payers.  Check your respective plan policies for additional information.2,3

Documentation Guidelines

According to CMS, documentation of history is required for all visits.   In addition, all services ordered rendered must have a signature. Ever heard of SFPMQOAP – Some Fine People May Quibble Over Apple Pie? CMS laid out documentation requirements along with this handy phrase to help us remember. 4

S – Symptoms causing patient to seek treatment

F – Family history, if relevant

P – Past health history

M – Mechanism of trauma

Q – Quality and character of symptoms/problems

O – Onset, duration, intensity, frequency, location and radiation of symptoms

A – Aggravating or relieving factors

P – Prior interventions, treatments, medications, and secondary complaints

What schemes to look out for?·      

Providers billing Active Treatment for an extended period of time

Cookie Cutter billing patterns – patients with the same diagnoses/treatment modalities

Providers resubmitting claims that were previously denied and adding the modifier

Look for providers who submit all or most of their claims with modifier -AT

Do not forget to check your respective plan policies, reimbursement guidelines, provider contracts and member evidence of coverage documents. 

If you have any questions or comments, please reach out to [email protected].