The Most Common Chiropractic CPT Modifiers

Chiropractic codes and modifiers are their own language. You need to use them correctly to get your bills paid. Chiropractic modifiers tell insurance companies that there is something different about the services related to the CPT code being billed. If you’re inaccurate with your modifiers, then it will negatively affect your reimbursement rate – and your bottom line. Below is a list of the top 10 modifiers and how and when they should be used. We hope this will help your billing team !!

59 — If the service provided is distinct or independent from other services provided on the same day. (should only be used when more specific modifiers, like X modifiers, are not appropriate).

XS — a service that is distinct because it was performed on a separate organ/structure.

XE — only used to describe separate encounters on the same DOS

XU — this service is distinct because it does not overlap usual components of the main service

XP — this service is distinct because it was performed by a different provider/practitioner

(note that XS, XE, XU and XP provide greater reporting specificity where 59 modifier was previously reported and each may be used in lieu of 59 when possible.)

AT — Used when patients are in active or corrective phase for Medicare contracted care when using CPT codes 98940, 98941, or 98942.

GA — Tells Medicare you don’t expect coverage as R&C, and the pt signed an ABN for that service, Upon denial Medicare will automatically assign liability to the beneficiary.

GY - Item or supply is not covered by Medicare but you intend to bill secondary. Not to be used on bundled or add on codes.

GZ — Tells Medicare you expect denial of R&C and pt has NOT signed ABN for this service. When denied, pt will not be responsible for payment

25 — If you perform and E/M service on same day as a procedure. The 25 goes on the E/M svc not the procedure. Do not add any other modifiers on the procedure in this case.