Pennsylvania Code
Title 34 - LABOR AND INDUSTRY
Part VIII - Bureau of Workers' Compensation
Chapter 127 - WORKERS' COMPENSATION MEDICAL COST CONTAINMENT
Subchapter B - MEDICAL FEES AND FEE REVIEW
CALCULATIONS
Section 127.106 - Outpatient providers subject to the Medicare fee schedule-spinal manipulation performed by Doctors of Osteopathic Medicine
Current through Register Vol. 54, No. 38, September 21, 2024
(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).
