E&M CPT procedure codes 99202–99203 and 99212–99214 and HCPCS procedure code G2212 are separately reimbursable for chiropractic providers when appropriate and performed on the initial visit of an SOI. Providers are expected to submit the correct E&M procedure code based on the level of complexity. While procedure codes 99203 and 99214 are reimbursable, these codes represent higher-complexity visits and would be expected to be submitted only in rare situations.
Note: Reimbursement is not available for extended or comprehensive E&M services (procedure codes 99204–99205 and 99215), for an unlisted E&M service (procedure code 99499), or for an E&M service that does not require the presence of a physician (procedure code 99211).
One E&M service is reimbursable per SOI; the E&M service must be on the same DOS as the initial visit for a new SOI where the new problem is diagnosed with a new treatment plan developed or the member is referred out to another provider.
An E&M service may be submitted on a claim with the same DOS as a manipulative treatment if it is significantly and separately identifiable, per the NCCI guidelines. In these situations, the E&M code must be submitted with modifier 25.
To select the appropriate E&M code set for new or established patients, providers should refer to CPT E&M coding guidelines and to policy in the Online Handbook. To determine the level of CPT procedure code to use, providers should refer to the federal CMS 1995, 1997, and 2021 "Documentation Guidelines for Evaluation and Management Services" and to policy in the Online Handbook.
Note: HCPCS procedure code G2212 is covered for prolonged services with or without direct patient contact as an add-on procedure code to CPT procedure codes 99205 and 99215. CPT procedure code 99417 is not covered as an add-on procedure code to procedure codes 99205 or 99215. The CMS website contains information regarding the HCPCS add-on procedure code G2212.