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News & Press: Medicare

Medicare update: 2% reduction for CPT codes eliminated

Monday, July 7, 2014  
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July 2014 Pricing Updates For Chiropractic Services – 98940, 98941 & 98942

Section 651 of Medicare Modernization Act (MMA) required the Secretary to conduct a demonstration for up to 2 years to evaluate expanding coverage for chiropractic services under Medicare. The demonstration, which ended on March 31, 2007, was required to be budget neutral.

Because the costs of this demonstration were higher than expected, CMS finalized a policy to recoup expenditures from this demonstration over a 5 year period from 2010 through 2014 (74 FR 61927) by adjusting payments for chiropractic services (CPT codes 98940, 98941, and 98942).

Based on an analysis of Medicare expenditures for chiropractic codes, OACT (Office of the Actuary) has determined that the remaining expenditures were recouped in the first half of 2014. Therefore, the July update eliminates the 2 percent reduction for CPT codes 98940, 98941, and 98942 that was utilized for the first half of CY 2014, effective July 1, 2014.

The new fee schedules reflect the elimination of the 2% demonstration reduction. These rates are effective for dates of service on and after July 1, 2014 that are processed or reprocessed on or after July 7, 2014.

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