by Brandy Brimhall, CPC CPCO CMCO CPMA QCC
March 3rd, 2017
Question: If a patient is treated with chiropractic manipulation and it is clinically appropriate but doesn't qualify as medically necessary care, what is the proper way to communicate this when billing the insurance company for the service? I would like to append the GA modifier, as we do with Medicare but private payers can't answer how to handle this. Can we use GA for all payers for this situation?
Answer: The GA modifier is exclusive to Medicare. There is not a maintenance care modifier for other payors. To code and bill for maintenance care treatment, you would use code S8990 - Physical or manipulative therapy performed for maintenance rather than restoration.