Impact on Medicare Payments by Specialty1 | |
(Partial Listing of Providers) | |
SPECIALTY | IMPACT OF CHANGES |
| 1. Chiropractor | +15.5% |
| 2. Anesthesiology | +5.2% |
| 4. Family Practice | +2.5% |
| 12. Neurology | +0.6% |
| 21. General Surgery | -2.5% |
| 26. Orthopedic Surgery | -3.4% |
| 30. Podiatry | -4.3% |
| 32. Radiology | -4.4% |
1. Federal Register. Vol. 61, No. 227, Nov. 22, 96 Rules and Regulations. | |
Being added to the CPT codes (published by the American Medical Association), and receiving a 15.5 percent increase in reimbursement is almost beyond belief. But the news is even better considering the 4.6 percent decrease chiropractic would have suffered under the A2000 coding as reported by the Federal Register on May 3, 1996.
Because the old A2000 code was not a CPT code, the Health Care Financing Administration (HCFA) did not assign a work value according to CPT protocol. This obviously resulted in a much lower reimbursement rate. The new CMT codes remedy this handicap because they have been analyzed and valued according to the HCFA-recommended protocol for establishing new work relative value units.
A year of persistent efforts by the American Chiropractic Association (ACA) resulted in the first-ever appointment of chiropractic representatives to two key AMA advisory committees in 1995: Drs. Jerilynn Kaibel and Craig Little. In addition, the ACA hired a prestigious health care consulting firm, The Lewin Group, to help develop accurate work values in support of new chiropractic-specific codes. Finally, to establish the credibility of the proposed work values for the chiropractic CPT codes, the ACA conducted a nation-wide survey of DCs, measuring the work value cost of manipulation services.
In addition to the increase in reimbursement rate, these new codes more adequately describe actual chiropractic practice. In place of A2000, there are now four codes: three for manipulation of the spine, and one for extra-spinal manipulation. The new CPT language includes the use of E/M codes which some insurance carriers have suggested were inappropriate for chiropractic application.
The inclusion of chiropractic in the CPT codes, plus the increased valuation, will have a ripple effect among those many non-Medicare plans, particularly those health plans that base their reimbursement rates on the CPT codes.
For a more detailed look at the new CMT codes, please be watching for a special question and answer article in the next issue of Dynamic Chiropractic.
Dynamic Chiropractic editorial staff members research, investigate and write articles for the publication on an ongoing basis. To contact the Editorial Department or submit an article of your own for consideration, email
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