(December 3, 2018 – Springfield, IL) – The Illinois Chiropractic Society (ICS) has been working with the American Medical Association (AMA) in 2018 to clarify problematic language published in 2007 in the CPT® Assistant. The ICS noted that the 2007 guidance was overly inclusive in the number and types of services bundled as part of chiropractic manipulative treatment (CMT). We are happy to report that the AMA has recently revised this language to remove from the CMT narrative some of the elements that are more appropriately characterized as part of a patient re-evaluation.
An important change was to remove the suggestion that CMT includes the evaluation of new complaints and modification of the current treatment plan. In reality, both services are typically a part of a re-evaluation of a patient and require more extensive physician time and effort than would be a part of the more regular CMT. In fact, insurers require that providers perform these distinct services at consistent intervals to demonstrate patient progress. However, we are aware that the original language in the 2007 CPT® Assistant article was being used to deny claims for these very services, creating a barrier to care for patients.
The process to improve the language included the AMA CPT® Assistant Editorial Board and a national chiropractic stakeholder group. These groups created the new language and appropriately removed the broad examination components and now contains more appropriate services specific to routine CMT. “These changes should assist doctors and patients overcome previous reimbursement challenges that used the 2007 language to reject appropriately billed services,” said Dr. Tim Bertelsman, ICS President. “Insurers should take note of the changes and aptly process claims, taking into consideration the new language.”
The ICS and AMA believe the new language is more appropriate to distinguish CMT from periodic evaluation services. The ICS applauds the AMA’s commitment to providing accurate and timely education on CPT codes.