How the New Modifier FX Will Affect Your Chiropractic Xray Payments

Effective January 1, 2017 Medicare released a new requirement and an accompanying new modifier that may have slipped under the radar for many chiropractors…for now.

The new modifier is FX and is required when you take plain film x-rays (as opposed to digital x-rays).

While chiropractors may think this ruling has no bearing on them (because Medicare does not reimburse x-rays taken in a chiropractic office), think again.

Commercial Payers Adopting New X-ray Modifier Requirement

Unfortunately, as Medicare goes, commercial payers tend to follow and the new modifier FX requirement is no exception, as it will affect your chiropractic payments.

For example, in Aetna’s March 2017 newsletter, it was reported that the FX modifier requirement goes into effect June 1, 2017 for COMMERCIAL plans.  Specifically, Aetna’s policy states the following:

Claims billed with modifier FX to indicate X-ray imaging services were provided using film reduces will be subject to a 20% reduction. The reduction applies to the technical component (TC) (including the TC portion of a global service).

To put it in plain English, if you take plain film x-rays in your office, your chiropractic payments will be affected by the modifier -FX. To be precise, most chiropractors utilize bill for BOTH the technical component (TC) which is the taking of the x-ray AND the professional component (PC) of the x-ray (which is the reading of the x-ray) by using the appropriate CPT code that signifies where the x-ray was taken (this is known as billing for the “global” service).  Offices who take films for other chiropractors would still be affected by this new ruling, as they are utilizing the Technical Component — which is the part of the x-ray that requires this modifier.

For those of you who may think that you can “forget” to apply the FX modifier to your plain film x-ray billings, take note that this is a policy requirement – not an option.  In other words, if you fail to appropriately code x-rays that should have the FX modifier appended, an audit would determine that you need to pay the extra money back to the payer and the proof is sitting in your x-ray storage area.

Chiropractors Should Expect to Be Paid Less for Plain Film X-rays Thanks to the FX Modifier

Unfortunately, for chiropractors who use plain film x-rays and have not yet made the switch to digital, you should anticipate that other payers will follow in a similar manner with their payment policies.  And the 20% payment reduction is the standard set by Medicare, so you should also anticipate that private payers will reduce their x-ray reimbursements by at least 20% — some will undoubtedly use this an opportunity to creatively argue for a greater reduction.

What if You Use Digital X-rays in Your Chiropractic Office?

Good news!  You are safe from this reporting requirement and your coding will be simple.  The new standard moving forward will be that x-ray codes are reported as they have been in the past.

So, there is NO additional coding needed to communicate that you ARE using digital x-rays.  The requirement is on the other side of the fence; if you are not using digital, you are required to code your films using the FX modifier.

Finally and fortunately, as a matter of clarification, the FX modifier does not affect the CPT codes you are billing for your chiropractic x-rays, as the CPT codes signifying the areas x-rayed are the same with or without the modifier.


Plan to see payer notifications informing you if and when their new FX policy will be in place. This is not Aetna’s fault and is not a policy that will only be adopted by them, but you should expect that MOST payers will adopt a similar policy (or have already).

Anticipate 20% payment reductions when you use the FX modifier for your chiropractic x-rays.

If you use x-rays frequently and haven’t made the switch yet, this may be a good time to do the math and consider switching to digital x-rays.

Want to learn the latest strategies and updates for working SMARTER with commercial insurance, Medicare and in your chiropractic business? That’s what our upcoming ChiroProgress SEMINARS are all about! We will be teaching just that: better Medicare, better insurance and better business strategies so you can quit working harder and start working smarter!


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