Have you heard of the FX modifier?
On January 1, 2017, the Centers for Medicare and Medicaid Services (CMS) implemented the required use of this modifier when radiology services are provided via plain film, vs. digital. For example, when two views of the cervical spine are taken, the modifier is appended to the x-ray code, like this 72040-FX. The modifier is a pricing modifier, which means a reduction of 20% off the technical component of the films if plain films are taken. If you take digital films, no change to coding is necessary, as this reduction doesn’t apply.
But Medicare doesn’t reimburse for x-rays when ordered or taken by chiropractors
If a Medicare beneficiary asks you to submit your bill for x-rays, you must include the FX modifier if the x-rays were taken on plain films. Of course, Medicare doesn’t reimburse for x-rays when ordered or taken by chiropractors, but as the saying goes: As Medicare goes, so goes the nation.
Effective June 1, 2017, Aetna requires an FX Modifier when billing plain film x-rays. Other carriers will likely follow suit.
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I am writing in regards to the KMC Compliance program my office signed up for. At first, I thought it would just be a program to look at our office and make sure we were doing things correctly, but as the meetings went on I realized the KMC program provided a ton of information at my fingertips. I have worked in chiropractic offices for 12 years (and currently work in two), and this is the first time I finally felt like I was receiving the answers to 'grey area' questions I've had for quite some time. I absolutely love the training videos, and the one on one meetings with you were greatly appreciated. We got knowledgeable and personalized answers based on our practices needs. I highly recommend this program to any practice considering it, having doctors and staff trained in this is an absolute necessity if that practice is accepting insurances. Thank you for all your help with making sure our office is compliant and has the knowledge to continue dealing with all the rules and regulations of very confusing insurance policies.