Current through Register Vol. 54, No. 45, November 9, 2024
Section 127.106 - Outpatient providers subject to the Medicare fee schedule-spinal manipulation performed by Doctors of Osteopathic Medicine(a) Payments for spinal manipulation procedures by Doctors of Osteopathic Medicine shall be based on the Medicare fee schedule for HCPCS codes M0702-M0730 (through 1993) or HCPCS codes 98925-98929 (1994 and thereafter), multiplied by 113%.(b) Payment shall be made for an office visit provided on the same day as a spinal manipulation only when the office visit represents a significant and separately identifiable service performed in addition to the manipulation. The office visit shall be billed under the proper level HCPCS codes 99201-99215, and shall require the use of the procedure code modifier "-25" (indicating a Significant, Separately Identifiable Evaluation Management Service by the Same Physician on the Day of a Procedure).(c) Payments for other services provided by Doctors of Osteopathic Medicine shall be calculated as provided for in § 127.104 (relating to outpatient providers subject to the Medicare fee schedule-physicians). This section cited in 34 Pa. Code § 127.101 (relating to medical fee caps-Medicare); 34 Pa. Code § 127.153 (relating to medical fee updates on and after January 1, 1995-outpatient providers, services and supplies subject to the Medicare fee schedule).