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

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

§ 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).

Source

   The provisions of this §  127.105 amended January 16, 1998, effective January 17, 1998, 28 Pa.B. 329. Immediately preceding text appears at serial pages (203453) to (203454).

Cross References

   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).

No part of the information on this site may be reproduced for profit or sold for profit.

This material has been drawn directly from the official Pennsylvania Code full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.