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Posting Date: 02/26/2022
MBI Lookup
MBI Lookup The MBI Lookup should be used when you have attempted to obtain a copy of the patient’s Medicare card or MBI from the patient or the patient’s caregiver. The MBI Lookup will allow you to search for and receive a patient’s MBI. [...]
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Posting Date: 09/10/2024
Expected Timeframes for Therapy Services
Expected Timeframes for Therapy Services CMS and CPT guidelines for provider time spent and documented on therapy services may vary, depending on the definition of the service and the context in which it is performed. View our Therapy [...]
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Posting Date: 11/07/2022
Health Professional Shortage Area
Health Professional Shortage Area Table of Contents What is a HPSA Eligible Providers HPSA Eligibility and Designation Claim Coding Requirements and Payment Locating a HPSA Designation on HRSA Website What Is a HPSA? A HPSA is an [...]
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Posting Date: 11/07/2022
CMS Incentive Payment Information
CMS Incentive Payment Information Program Information Quarterly and annually, CMS issues special incentive payments to EPs that participate in the following incentive programs. Providers are welcome to use the information below to [...]
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Posting Date: 11/11/2021
Introduction to Chiropractic Services
Medicare Coverage of Chiropractic Services Introduction to Chiropractic Services A chiropractor must be licensed or legally authorized to furnish chiropractic services by the state or jurisdiction in which the services are furnished. In [...]
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Posting Date: 04/23/2021
Chiropractic Coverage
Medicare Coverage of Chiropractic Services Chiropractic Coverage Medicare pays chiropractors for spinal manipulation CPT codes 98940–98942, when these services are reasonably and medically necessary and meet all Medicare coverage guidelines [...]
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Posting Date: 11/11/2021
Maintenance Care for Chiropractic Services
Medicare Coverage of Chiropractic Services Maintenance Care for Chiropractic Services Medicare coverage for chiropractic services extends only to treatment by means of manual manipulation of the spine to correct a subluxation, provided such [...]
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Posting Date: 11/11/2021
Medical Review Audits
Medicare Coverage of Chiropractic Services Medical Review Audits Medicare contractors perform medical review audits to ensure Medicare is paying providers for appropriately covered Medicare services. Medical review examines documentation [...]
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Posting Date: 11/11/2021
Proper Billing for Acupuncture
Medicare Coverage of Chiropractic Services Proper Billing for Acupuncture Decision Memo for Acupuncture for Chronic Low Back Pain (CAG-00452N) Reviewed 9/11/2024
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Posting Date: 11/11/2021
Limited Coverage for Services Ordered or Furnished By a Chiropractor
Limited Coverage for Services Ordered or Furnished By a Chiropractor This article is to remind chiropractors and facilities that X-rays and other diagnostic tests are statutorily excluded services when ordered or furnished by a chiropractor. [...]
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Posting Date: 11/11/2021
Documentation to Support Spinal Manipulation for CPT Code 98942
Documentation to Support Spinal Manipulation for CPT Code 98942 It is not uncommon for chiropractic doctors to perform a full-spine or multi-level manipulation, even when the symptoms or diagnosis reflect a single region. This is a matter of [...]
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Posting Date: 11/11/2021
Advance Beneficiary Notice of Noncoverage Liability
Medicare Coverage of Chiropractic Services Advance Beneficiary Notice of Noncoverage Liability The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is a standardized notice that a health care provider/supplier or his/her [...]
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Posting Date: 11/11/2021
Chiropractic Resources
Medicare Coverage of Chiropractic Services Chiropractic Resources Code of Federal Regulations Code of Federal Regulations (Annual Edition) web page 42 CFR Section 410.21 describes limitations on services of a chiropractor 42 CFR [...]
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Posting Date: 07/21/2023
Original Medicare First Level of Appeal Tips Sheet for Medicare Providers
Original Medicare First Level of Appeal Tips Sheet for Medicare Providers If you disagree with Medicare’s claim determination, you may appeal. However, please follow these important tips before you submit a first level of appeal [...]
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Posting Date: 10/27/2022
Coverage of Rural Air Ambulance Services
Coverage of Rural Air Ambulance Services Section 415 of the Medicare Modernization Act of 2003 provides coverage for rural air ambulance services that are reasonable and necessary and ordered by qualified personnel. Medicare considers the [...]
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Posting Date: 06/01/2020
New York State Ambulance Services in Rural Areas (for JK providers only)
New York State Ambulance Services in Rural Areas NYS has unique requirements for the payment of paramedic intercept services when an ambulance company can provide only BLS services. Paramedic intercept services can be approved in counties and [...]
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Posting Date: 03/08/2023
PECOS Starter Guide
PECOS Starter Guide Follow the steps outlined below to assist you and your staff with the PECOS processes. Table of Contents New/Initial Enrollee Revalidation Return for Corrections Change of Information Submit Pending Application [...]
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Posting Date: 10/31/2022
General Information
General Information Original Medicare does not normally cover routine vision services, such as eyeglasses and eye exams. Medicare may cover some vision costs if associated with other covered expenses (that is, Medicare may cover some vision [...]
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