MEDICARE DEMONSTRATION PROJECT ARCHIVE
 
   
This Page is the Archive of materials used during the 2-year Medicare Demonstration Project and its followup.

 
   
The Medicare Demonstration Project Archive

This section was compiled by Frank M. Painter, D.C.
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The Medicare Demonstration Project
 
   

Medicare Demonstration Projects & Evaluation Reports
The Centers for Medicare & Medicaid Services (CMS)

The Centers for Medicare & Medicaid Services conducts and sponsors a number of innovative demonstration projects to test and measure the effect of potential program changes. Our demonstrations study the likely impact of new methods of service delivery, coverage of new types of service, and new payment approaches on beneficiaries, providers, health plans, states, and the Medicare Trust Funds. Evaluation projects validate our research and demonstration findings and help us monitor the effectiveness of Medicare, Medicaid, and the Children's Health Insurance Program (CHIP).

 
   

The Medicare Demonstration Project
 
   

MedLearn Matters: The Chiropractic Expansion Project   (PDF)
Medicare April 4, 2005

This 20–page Adobe Acrobat file (412 KB) gives you CPT and DX codes that Medicare is going to pay for, and also lists zip codes that are going to be in the project areas. Really alot of information here.

Medicare Revises Requirements For Chiropractic Billing
Center for Medicare and Medicaid ~ FULL TEXT

The Center for Medicare and Medicaid Services (CMS) has issued revised requirements for chiropractic billing of active/corrective treatment and maintenance therapy. As of 10-01-2004 every chiropractic claim (those containing HCPCS code 98940, 98941, 98942) should include the Acute Treatment modifier (AT) if active/corrective treatment is being performed.

Congress Approves Plan to Test Expanded Medicare Access to DCs
www.acatoday.com

The current Medicare program imposes an arbitrary limit on the covered services that can be offered by America's 60,000 doctors of chiropractic and sought by millions of older chiropractic patients. Under current law, a chiropractor may only provide Medicare beneficiaries with a single covered service (manual manipulation of the spine to correct a subluxation) despite the fact that they are licensed in all 50 states to provide additional services that are currently covered under Medicare, including x-rays and other diagnostic tests and physiotherapy services. The ACA has long contended that Medicare's arbitrary limit on chiropractic services is harmful to patients and costly to taxpayers. The four-site, two-year demonstration, will likely have a profound impact in rural and medically underserved areas where beneficiaries will no longer be forced to visit a second or third provider to receive the full range of necessary services.

The Chiropractor's Guide
Compiled by Lisa Paoli, CMRS of MedOffice Solutions

This 8-page document (also available as a Word document ~ 72 KB) covers proper coding recomendations specifically for Illinois providers. Thanks Lisa! Updated on 6-11-2005

Medicare's Chiropractic Demonstration Project
Federal Register: Jan. 28, 2005; 70 (18): 4130–4132 ~ FULL TEXT

Read the details of the Medicare Chiropractic Demonstration Project, which will test expanded access to chiropractic services for America's senior citizens in a two-year, four-site demonstration project starting April 2005. Review this document for locations and the expanded services chiropractors will be able to provide.

Medicare's Primary Recommendations For HCFA Filing

  • AT modifier - The AT modifier should be used for every service on all demonstration claims where active/corrective treatment is provided.

  • DEMO 45 - Demo 45 must be indicated in block 19 of the CMS 1500 claim form for all demonstration claims. For electronic submissions, it would be REF02 (REF01=P4) in the 2300 loop.

  • Separate Demonstration services (Physical Therapy) from spinal CMT - All claims for demonstration services should be submitted on a separate claim form from claims from spinal CMT (98940, 98941, 98942).

  • GP modifier - The GP modifier should be used for all therapy services.

  • 25 modifier - When manipulation and E&M codes are billed on the same visit, it is necessary to attach a 25 modifier to the E/M code.

  • Local Coverage Determinations (LCDs) - Chiropractors must follow local coverage determinations for therapy and other demonstration services—this is particularly important for therapy services. They must also ensure that appropriate diagnosis codes are used for each procedure. Information regarding LCDs can be found on your carrier websites.


Medicare Modifiers
MODIFIER      USAGE
AT

The Acute Treatment (AT) modifier must be attached to the spinal manipulative CPT codes (98940, 98941, or 98942) to distinguish it from unpaid maintenance visits.

GP

Identifies the service as "Physical Therapy". In Illinois I have have been advised that all PT codes must be submitted with BOTH the AT (acute treatment) AND GP modifiers attached like this: Code - ATGP. In non-demonstration areas, GP, coupled with the GY modifier, tells Medicare you know that this is a non-covered therapy.

GY

This indicates to Medicare that you know that this is a non-covered service (like Physical Therapy services outside of the Demonstration Project areas).

GA

This indicates that Medicare will deny a covered service as not reasonable and necessary, and that the provider has an ABN signed by the beneficiary.

GZ

This indicates that Medicare will deny a covered service as not reasonable and necessary, and that the provider does NOT have an ABN signed by the beneficiary.

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Updated 8-11-2021

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