Forum - Questions & Answers

Jan 22nd, 2020 - phil.jen 2 

CPT 99213 w/ 98941, 97110 or 97140 for Aetna

Does anyone have any suggestions on billing 99213 w/ 98941, 97110 or 97140? All office visits get denied, stating that they can't be done on the same day as manipulation or therapy. So, we had a patient willing to come in one day for the office visit & then came in the next business day (two days later) for manipulation and therapy. 99213 was once again denied, stating it was not medically necessary.

Someone, please help!

Jan 22nd, 2020 - ChrisW   256  1 

re: CPT 99213 w/ 98941, 97110 or 97140 for Aetna

98940-98943 manipulation codes cover three components for this service which are all bundled together within the code description

1) Pre-assessment of the patient, which means you are going to examine the patient, palpate the patient, and possibly perform an orthopedic test.

2) The Chiropractic Manipulative Treatment (CMT).

3) Post-assessment, where you evaluate the results of the treatment.

Only in certain cases where ‚Äúsignificant, separately and identifiable‚ÄĚ E/M services are performed in addition to the three steps identified by the 9894x code set should you consider adding an additional E/M code, and then you would need to append a -25 modifier to the appropriate E/M code selected.

I would also suggest viewing the policy and exclusions of the plan, The following can be found on under Commercial payer policies Aetna, policy number: 0107. Aetna's policy states, "if no improvement is documented within 30 days despite modification of chiropractic treatment, continued chiropractic treatment is considered not medically necessary."

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