R 418.10203 Office visit or other outpatient visit for evaluation and management of patient in conjunction with ongoing osteopathic manipulative treatment or chiropractic manipulative treatment.

Rule 203. (1) The carrier shall reimburse for the initial evaluation and management examination billed by the provider before initiating chiropractic or osteopathic manipulation. The carrier shall also reimburse for osteopathic manipulative treatment or chiropractic manipulative treatment if the treatment is initiated on the same date of service. (2) All of the following provisions apply to ongoing osteopathic manipulative treatment: (a) Osteopathic manipulative treatment procedure codes include pre-manipulative patient evaluation. The physician may bill a separate evaluation and management service using modifier code -25. The carrier shall only reimburse the service if the documentation provided supports significant change of signs and symptoms or the evaluation of another work related problem not included in the procedure or service that required the encounter. The physician shall document the rationale for the significant other service in the record. (b) Osteopathic manipulations are to be billed using procedure codes 98925-98929. (3) All of the following provisions apply to ongoing chiropractic manipulative treatment: (a) The chiropractic manipulative treatment codes include a pre-manipulation patient evaluation. The provider may report a separate evaluation and management service using modifier -25 to designate a separate identifiable service. The carrier shall reimburse the evaluation and management service only when the provider documents significant change of signs and symptoms or the evaluation of another work related problem not included in the procedure or service that required the encounter. The provider shall document the rationale for the significant other service in the record. (b) The carrier shall reimburse chiropractic manipulative treatment when the provider bills the service with procedure codes 98940-98942. (4) If either a doctor of osteopathy or a doctor of chiropractic, conducts a periodic re- evaluation, then a report of the evaluation shall accompany the bill. A periodic re-evaluation report shall include all of the following information: (a) A description of the evaluation of function in measurable terms based on physical findings and problem identification. (b) A goal statement. (c) A treatment plan. (d) Physical and functional improvement in measurable terms that has occurred in relationship to the diagnosis for which the treatment was prescribed. (e) The likelihood of continued improvement if treatment is continued.