2023 Medicare Chiropractic Billing and Regulatory Updates

Highlights

• Your practice must follow regulatory and CPT code updates for 2023 to stay compliant with Medicare chiropractic billing.
• Regarding the No Surprises Act, providers must continue to disclose good faith estimates while understanding changes to Medicare beneficiaries’ premiums and reimbursement rates.
• The updated E/M guidelines reflect the simplification of the CPT codes, allowing chiropractors to spend more time on patient care.

Understanding the updated chiropractic billing and coding regulations for 2023 is important for running your practice efficiently, staying compliant, and collecting the right amount for your chiropractic services. Review the following chiropractic regulatory changes for 2023 to understand how they may impact your practice’s billing methods and daily operations.

No Surprises Act Changes for Chiropractic Billing

The newest changes to the No Surprises Act regulations affect chiropractic practices serving self-pay, uninsured and insured patients. These shifts impact the disclosure of good faith estimates (GFEs) and descriptions of benefits to patients.

Continued Enforcement Discretion for GFEs

The Department of Health and Human Services (HHS) announced a delay in enforcing the rule under the No Surprises Act requiring facilities and providers to provide a good faith estimate (GFE) of expected charges to uninsured and self-pay patients. The HHS indicated they would use enforcement discretion for cases when GFEs don’t include expected charges for specific external co-providers or co-facilities.

The HHS requires providers and facilities to include the cost of services provided by co-providers in their GFEs. The expiration date for enforcement discretion was scheduled for January 1, 2023. On January 1, the HHS began requiring practices with multiple providers who serve uninsured or self-insured patients to create GFEs that list data for co-provider services.

However, the HHS delayed the deadline due to technical difficulties encountered by co-providers when setting up their systems to connect with convening providers and facilities for GFEs. HHS has extended its enforcement deadline, giving providers and facilities more time to fully implement the GFE requirements and comply with the new rules.

In the meantime, convening facilities or providers must include the expected cost of services in their GFEs, even if they do not include co-provider charges.

2023 Medicare Part B and C Changes

Chiropractic Medicare changes include decreases in premiums for Medicare Part B and Medicare Part C, known as Medicare Advantage, to help patients save money. These lower physician reimbursement rates from Medicare may affect revenue flows for chiropractic practices.

Changes in Medicare Part B and C Premiums

Medicare beneficiaries often use their Social Security payments to cover their Part B premiums. Since Social Security’s cost-of-living adjustment (COLA) increased benefits by 8.7% for 2023, beneficiaries and enrollees will save more money on their premiums for 2023, as follows.

• An average monthly premium of $164.90 for Medicare Part B enrollees, down from $170.10 in 2022.
• Annual deductible of $226 for Medicare Part B beneficiaries, a decline of $233 from the previous year.
• Monthly premium of $18 for people enrolled in a Medicare Advantage Plan or  Medicare Part C, reduced from $19.52 in 2022.

Lower Medicare Reimbursement Rates for Providers

CMS’s 2023 Physician Fee Schedule includes conversion factor changes. The 2023 conversion factor is $33.06, a decrease of $1.55 from the 2022 conversion factor of $35.71, resulting in a decline in Medicare payments for practitioners.

Medical groups such as the American Medical Association attempted to avert an 8.5% reduction in Medicare reimbursements. However, the passage of the 2023 Omnibus Appropriations Bill cut the Medicare payment rate for 2023 by 2.5% and 1.25% for 2024. The Medicare cuts for practitioners have led some chiropractors to consider how to maintain their practice’s financial viability and access to care for patients who are Medicare beneficiaries.

New Evaluation and Management Code Information

Several chiropractic code changes for 2023 simplify the language used for evaluation/management (E/M) codes. These chiropractic billing changes for 2023 create consistency among payers and practices, including details and accurate Medicare chiropractic billing under CMS’s E/M guidelines:

• Use of new descriptor times when appropriate
• Updated interpretive guidelines for medical decision-making levels
• Selection of medical decision-making or the time to choose a code level, except for emergency department visits and timed services like cognitive impairment examinations
• A medically appropriate history and examination to replace the use of history and examination to determine code level

The new and revised codes for chiropractic practices and billers include:

Inpatient and Observation Care Services

There was a deletion of observation CPT codes in favor of the existing hospital care CPT codes such as 99221, 99222, 99223, 99221 to 99233, and 99238 to 99239. Revisions to the code descriptors now reflect the structure of the encounter date or the level of medical decision-making (MDM).

Consultations

A confusing set of guidelines has been removed, including the definition of “transfer of care.” There are no longer consultation codes for offices (99241) and inpatients (99251) to align with the four levels of MDM.

Nursing Facilities

The guidelines for nursing facilities include multiple morbidities requiring intensive management. Nursing facilities should consider this rule when providing initial care.CPT code 99318 for an annual assessment of nursing facilities has been eliminated. Instead, these services now fall under Medicare G codes or subsequent nursing facility care.

Home and Residence Services

The home visit codes 99341 to 99350 replaced the domiciliary or rest home CPT codes 99334 to 99340. The new patient code does not have a duplicate MDM level.

Emergency Services

The CPT codes for emergency services do not include time as an essential factor for choosing a code level. Instead, the modified MDM levels must align with office visits and be unique for each one. The existing CPT code numbers remain in use. Physicians and qualified health plans — in addition to emergency department personnel — may use these chiropractic billing codes.

Prolonged Services

The new code, 993X0, corresponds to the 99417 code for office visit prolonged services. This code is for use with observation, inpatient, or nursing facility services. Codes 99358 and 99359 are for use on dates other than those reported for the total time on the encounter date.

Keep Your Chiropractic Billing Practices Up-To-Date With ChiroTouch

Staying current on the latest regulatory and Medicare updates is necessary for accurate Medicare chiropractic billing. ChiroTouch helps you streamline your chiropractic billing workflow and reduce the risk of costly data entry errors with automated coding and billing features.

ChiroTouch chiropractic practice management software also supports automated documentation and integrated payment processing to ensure your compliance with CMS regulations.