34 Pa. Code § 127.105 - Outpatient providers subject to the Medicare fee schedule-chiropractors

(a) Payments for services rendered by chiropractors shall be made for those services permitted by the Chiropractic Practice Act (63 P. S. §§ 625.101-625.1106).

(b) Payments for spinal manipulation procedures by chiropractors shall be based on the Medicare fee schedule for HCPCS codes 98940-98943, multiplied by 113%.

(c) Payments for physiological therapeutic procedures by chiropractors shall be based on the Medicare fee schedule for HCPCS codes 97010-97799, multiplied by 113%.

(d) Payments shall be made for documented office visits and shall be based on the Medicare fee schedule for HCPCS codes 99201-99205 and 99211-99215, multiplied by 113%.

(e) Payment shall be made for an office visit provided on the same day as another procedure only when the office visit represents a significant and separately identifiable service performed in addition to the other procedure. The office visit shall be billed under the proper level HCPCS codes 99201-99215, and shall require the use of the procedure code modifier "-25" (indicating a Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Day of a Procedure).

Notes

34 Pa. Code § 127.105

The provisions of this § 127.105 amended January 16, 1998, effective 1/17/1998, 28 Pa.B. 329.

This section cited in 34 Pa. Code § 127.101 (relating to medical fee caps-Medicare); 34 Pa. Code § 127.153 (relating to medical fee updates on and after January 1, 1995-outpatient providers, services and supplies subject to the Medicare fee schedule).