chiropractic billing denial reason

REASONS FOR DENIAL

* When the number of manipulations exceeds the norm. (This type of denial will still require a claim be submitted to Medicare.)

* Excluded Services: An excluded service from Medicare coverage is any service other than manual manipulation for treatment of subluxation of the spine. The chiropractor is not required to bill excluded services; however, the provider may bill these services to Medicare to obtain a denial for secondary insurance purposes. The following are examples (not an all-inclusive list) of services that, when performed or ordered by the chiropractor, are excluded from Medicare coverage and for which the beneficiary is responsible for payment:

o Therapy for a chronic condition that does not meet the definition as described in the “Indications and Limitations and/or Medical Necessity” section of this policy.
o Laboratory tests.
o X-rays.
o Office visits (history and physical).
o Physical therapy.
o Supplies.
o Injections.
o Drugs.
o EKGs or any diagnostic study.

o
Acupuncture.
o
Orthopedic devices.
o
Nutritional supplements/counseling.
o Any service ordered by the chiropractor.
* Any manipulation, including low-force technique, where one of the absolute contraindications listed in this policy exists.

* Mechanical or electric equipment that is used for manipulations and does not meet the definition of “manual device” as specified in the “Description” section of this policy.
* Coverage will be denied for lack of reasonable expectation that the continuation of treatment would result in long-term improvement of the patient’s condition; continued repetitive treatment without an achievable and clearly defined goal is considered maintenance therapy and is not covered.
* The service is considered an extraspinal CMT.
* The service does not follow the guidelines of this policy.