Medicare covered DX code for chiropractic billing

ICD-9-CM Codes That Support Medical Necessity
The CPT/HCPCS codes included in this LCD will be subjected to “procedure to diagnosis” editing. The following lists include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as not medically necessary.
Medicare is establishing the following limited coverage for CPT/HCPCS codes 98940, 98941 and 98942:

Primary Diagnosis Codes
Covered for:

739.0–739.5
Non-allopathic lesions, not elsewhere classified

Secondary Diagnosis Codes
Group A Diagnoses
Covered for:

307.81
Tension headache
719.48*
Pain in joint, other specified sites

*Note: When using 719.48, providers must specify spine as the site.
723.1
Cervicalgia
724.1–724.2
Other and unspecified disorders of back
724.5
Backache, unspecified
724.8
Other symptoms referable to back
728.85
Spasm of muscle
784.0
Headache
Group B Diagnoses
Covered for:

720.1
Spinal enthesopathy
721.0–721.2
Spondylosis and allied disorders (arthritis, osteoarthritis, spondyloarthritis)
721.6
Ankylosing vertebral hyperostosis
721.90–721.91
Spondylosis of unspecified site
724.79
Disorders of coccyx, coccygodynia
729.1
Myalgia and myositis, unspecified
729.4
Fasciitis, unspecified
846.0–846.3
Sprains and strains of sacroiliac region
846.8
Sprains and strains of other specified sites of sacroiliac region
847.0–847.4
Sprains and strains of other and unspecified parts of back
Group C Diagnoses
Covered for:

353.0–353.4
Nerve root and plexus disorders
353.8
Other nerve root and plexus disorders
722.91–722.93
Other and unspecified disc disorder
723.0
Spinal stenosis in cervical region
723.2–723.5
Other disorders of cervical region
Group D Diagnoses
Covered for:

721.3
Lumbosacral spondylosis without myelopathy
721.41–721.42
Lumbosacral spondylosis with myelopathy
721.7
Traumatic spondylopathy
722.0
Displacement of cervical intervertebral disc without myelopathy
722.10–722.11
Displacement of thoracic or lumbar intervertebral disc without myelopathy
722.4
Degeneration of cervical intervertebral disc
722.51–722.52
Degeneration of thoracic or lumbar intervertebral disc
722.6
Degeneration of intervertebral disc site unspecified
722.81–722.83
Postlaminectomy syndrome
724.01–724.03
Spinal stenosis, other than cervical
724.3–724.4
Other and unspecified disorders of back
724.6
Disorders of sacrum, ankylosis
738.4
Acquired spondylolisthesis
756.11–756.12
Anomalies of spine
839.01–839.08
Other, multiple and ill-defined dislocations, cervical vertebra
839.20–839.21
Other, multiple and ill-defined dislocations, thoracic and lumbar vertebra, closed
839.41–839.42
Other, multiple and ill-defined dislocations, other vertebra, closed
953.0–953.4
Injury to nerve roots and spinal plexus
Note: Providers should continue to submit ICD-9-CM diagnosis codes without decimals on their claim forms and electronic claims.
Diagnoses that Support Medical Necessity
N/A
ICD-9-CM Codes That DO NOT Support Medical Necessity
N/A
Diagnoses That DO NOT Support Medical Necessity
All diagnoses not listed in the “ICD-9-CM Codes That Support Medical Necessity” section of this LCD.
Documentation Requirements
Documentation supporting medical necessity should be legible, maintained in the patient’s medical record and made available to Medicare upon request.
Please see Medicare Benefit Manual sections referenced above for national documentation requirements for Medicare payment of chiropractic services

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