LCD and Article Updates for August/September 2024

LCD and Article Updates for August/September 2024 Local Coverage Determinations Facet Joint Interventions for Pain Management L35936 Effective 8/1/2024 - Updated "Coverage Indications, Limitations and/or Medical Necessity" with the [...]

Telligen QIN-QIO Hosting Chronic Kidney Disease Topics with National Kidney Foundation

Telligen QIN-QIO Hosting Chronic Kidney Disease Topics with National Kidney Foundation Chronic kidney disease (CKD) affects more than 1 in 7 U.S. adults—an estimated 37 million Americans. For Americans with diabetes or high blood pressure—the [...]

Therapy Timeframes

Common Working File (CWF) Host Dark Days for October 2024 Release

Common Working File Host Dark Days for October 2024 Release For the upcoming October 2024 Release: For Production, CWF will be observing the Gray Day on Thursday, 10/3/2024, and Dark Days starting Friday, 10/4/2024 through Sunday, 10/6/2024 [...]

Psychotherapy Services and Targeted Probe and Educate

Psychotherapy Services and Targeted Probe and Educate We’ve added a new section to our website for Psychotherapy Services. Visit this page for informative instruction about completing a psychotherapy treatment plan, the required components to [...]

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. [...]

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 [...]

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 [...]

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 [...]

RuralServ

NGS RuralServ Our rural health providers face unique challenges in delivering quality of care to Medicare beneficiaries and in the associated administrative functions to file claims to Medicare. The RuralServ section of our website provides [...]

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 [...]

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 [...]

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 [...]

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 [...]

Modifiers

Medicare Coverage of Chiropractic Services Modifiers AT Modifier Used to indicate that the covered services billed are for active corrective treatment and the provider’s documentation supports medical necessity and Medicare coverage [...]

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

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. [...]

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 [...]

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 [...]

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 [...]