-
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 [...]
Read More -
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 [...]
Read More -
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 [...]
Read More -
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 [...]
Read More -
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
Read More -
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. [...]
Read More -
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 [...]
Read More -
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 [...]
Read More -
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 [...]
Read More -
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 [...]
Read More -
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 [...]
Read More -
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 [...]
Read More -
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 [...]
Read More -
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 [...]
Read More -
Posting Date: 10/31/2022
Provider Qualifications
Provider Qualifications Definition Ophthalmologist An ophthalmologist is a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) who has completed medical school and an ophthalmology residency that specialized in eye and [...]
Read More -
Posting Date: 10/31/2022
Local Coverage Determinations
Local Coverage Determinations Table of Contents Cataract Extraction LCD L33558 Corneal Pachymetry LCD L33630 Coding Guidelines Ophthalmic Biometry for Intraocular Lens Power Calculation LCD L33621 A-Scan Ultrasound Ophthalmic [...]
Read More -
Posting Date: 10/31/2022
National Coverage Determinations
National Coverage Determinations Table of Contents Hydrophilic Contact Lens for Corneal Bandage Photodynamic Therapy Ocular Photodynamic Therapy Photosensitive Drugs Verteporfin Hydrophilic Contact Lenses Scleral Shell Intraocular [...]
Read More -
Posting Date: 10/31/2022
Limitation of Liability (Advance Beneficiary Notice)
Limitation of Liability (Advance Beneficiary Notice) Services denied as not reasonable and medically necessary, under Section 1862(a) (1) of the Social Security Act, are subject to the Limitation of Liability (ABN) provision. The ABN is a [...]
Read More -
Posting Date: 10/31/2022
Glaucoma Screening ‒ Preventive Services Coverage
Glaucoma Screening ‒ Preventive Services Coverage Medicare provides coverage of an annual glaucoma screening for beneficiaries in at least one of the following high-risk groups: Individuals with diabetes mellitus; Individuals with a family [...]
Read More