As of April 1, 2010, Medicare would like providers to use a new modifier (GX) for all non-covered services. For chiropractors, this means –GX should be placed on all codes other than 98940-98942.

 

It is important to note that the –GX modifier means that a valid ABN is on file for the non-covered services for which the –GX is used.  Please update your New Patient intake procedures to include the signing of a single ABN with all the non-covered services you may do. You will also want to do the same thing for your existing Medicare patient base as they come in.  As far as we can tell, you only need to do this “ABN for Non-Covered” once.

 

You will want to use a different ABN (ABN for Maintenance) for the 98940-98942 codes only when you determine a patient has reached maintenance status.  This one can be good for up to one year, as long as that is the doctor’s plan… “Mary, I recommend you come in for maintenance adjustments every other week for the next twelve months.”

 

At the time of signing either ABN, the patient should be given a copy.

 

Billing scenarios:

 

99203 -25 –GX –GY	(ABN for Non-Covered on file)
97110 –GX –GP –GY	(ABN for Non-Covered on file)
98941 –GA	(ABN for Maintenance on file)
97035 –GY	(ABN for Non-Covered NOT on file)

 

Note:  –GY means statutorily excluded service.  –GP means physical therapy procedure.

 

 

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