Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Chiropractic)
Chiropractic
Manipulation with Visit
If an evaluation and management service is done with the
manipulation, the E/M will deny unless it is submitted with a -25
modifier, signifying significant, separately identifiable illness or
injury. A level 4 or 5 E/M (99204, 99205, 99214, 99215) will be
denied as provider liability because these levels would require
significant additional work, and it is seldom appropriate to bill
both.
Manual Therapy 97140, manual therapy techniques (e.g., mobilization/
manipulation, manual lymphatic drainage, manual traction), one or
more regions, each 15 minutes.
11-4
Blue Cross and Blue Shield of Minnesota and Blue Plus will not
reimburse providers for manual therapy services. Manual therapy
will deny either as incidental (provider liability) or subscriber
liability.
Provider liable:
Manual therapy (97140) will be denied incidental (provider liable)
to chiropractic manipulations billed on the same date of service.
The denial will be upheld regardless of submission of the -59
modifier. Based on chart documentation review, Blue Cross found
that manual therapy services submitted with the -59 modifier did
not clearly indicate it as a distinct service. Thus we have adopted a
corporate policy to disallow 97140 submitted with the -59
modifier. Additionally, submission of the -GA modifier will not
affect or change the denial.
Patient Billing Impact
The patient is not responsible and must not be balance billed for
any procedures for which payment has been denied or reduced by
Blue Cross as the result of a coding edit. Edit denials are designed
to ensure appropriate coding and to assist in processing claims
accurately and consistently.
Subscriber liable:
Coverage for manual therapy (97140) services provided without a
chiropractic manipulation is subject to the members’ contract
benefits.
Blue Cross Blue Shield of Minnesota Provider Policy and Procedure Manual (03/06/12)