chiropractic billing denial reason


* 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.

Orthopedic devices.
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.


Chiropractic billing software said...

Your blog is quite informative and resourceful which helped me to understand chiropractic billing denial.Thanks for sharing.
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Anonymous said...

this is somewhat misleading as gp modifier can not be billed on a timed modalities for commercial insurance

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