How do I fill out the HCFA claims forms when using the new codes?
Under the new chiropractic manipulative treatment (CMT) codes, doctors of chiropractic may now bill for a service which can include manipulations in up to five spinal regions. For Medicare purposes, a primary diagnosis of subluxation is required for each spinal region manipulated, backed by a secondary diagnosis (from categories I, II, or III) as appropriate. This could potentially lead to 10 separate diagnoses: five primary and five secondary. However, both the HCFA-1500 claim form (Item 21) and electronic billing form in the National Standard Format (NSF) Record FAO (fields 30-33) currently have space for up to four diagnoses only. Given this situation, an addendum to the Carrier Medical Director’s Chiropractic Model Policy outlines the appropriate way to fill out the claims form as follows: • For CMT code 98940 (1-2 regions), list all appropriate diagnoses (up to two primary and two secondary) in either item 21 of the HCFA-1500 or field(s) 30-33 of the NSF Record FAO. • For CMT code