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Medicare Specific Information

Medicare Webinar for Chiropractic - Webinar Link  This webinar teaches processing rules necessary to get Medicare claims paid for chiropractors. It discusses secondary diagnoses for neuromuscular skeletal as well as initial treatment date, necessary modifiers and claim documentation.

The payment guidelines for the secondary diagnosis codes differ by the company that is contracted to provide Medicare services for your state. Look at the guidelines below for your particular state.    Some guidelines show you the codes for short-term, moderate and long-term diagnoses. Some guidelines show you absolutely nothing for the secondary diagnosis codes!  It differs by the company that is processing Medicare claims for your state.

Medicare Payment Guidelines - IA, IN, KS, MI, MS, NE - Wisconsin Physician Services - WPS teaches you about Medicare processing guidelines used by Wisconsin physician services when they are processing Medicare claims for chiropractors.  It tells you the acceptable secondary diagnosis codes for neuromuscular skeletal diagnosis.  It divides them into groups for short-term, moderate term and long-term care. Obviously, more visits will be approved for long-term care than the number of visits approved for short-term.

Medicare Payment Guidelines - CT, NY, IL, MA, ME, MN, NH, RI, VT, WI - National Government Services - NGS does not provide a list of the secondary diagnosis codes that they find acceptable.  The only codes that they reference are the primary diagnosis codes the M99 series.

Medicare Payment Guidelines - KY, OH - CGS Administrators - CGS provides a list of secondary codes that they will accept. They do not divide them into groupings for short-term, moderate term or long term care.  They do, however, tell you which code they will accept.

Medicare Payment Guidelines - AK, AZ,CA, HI, ID, MT, ND, NV,OR, SD, UT, WA, WY Samoa, Guam - Noridian - Noridian provides a very complete list of acceptable diagnosis codes and divides them into short-term, moderate term and long term care. Obviously, more visits will be approved for long-term care than the number of visits approved for short-term.

Medicare Payment Guidelines - AR, CO, DC, DE, MD, NJ, NM. OK. PA, TX, LA, MS, VA (includes Part B for counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia)  - Novitas - Provides a comprehensive list of acceptable neuromuscular skeletal diagnosis codes and groups them into three groups. They include many codes that are not approved by other companies. Be sure to access their list of codes when you are entering secondary diagnosis codes.

Medicare Payment Guidelines - NC, SC, VA, WV, VA (excludes Part B for the counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia) - Palmetto GBA - Palmetto references the NGS guidelines would have no information about acceptable secondary neuromuscular skeletal diagnosis codes.

Medicare Payment Guidelines - IN, MI, IA, KS, MO, NE - Wisconsin Physician Services provides a very complete set of guidelines including short, moderate and long-term diagnosis codes.

Medicare Payment Guidelines - FL, Puerto Rico, the Virgin Islands - First Coast -There are no specifications available at all.

Medicare Processors by State this is a list of Medicare contractors (processors) by state, so that you can look up who is contracted to process Medicare Part B for your state.

Enrolling in EDI for your Medicare processor:

Cahaba: http://www.cahabagba.com/part-b/enrollment-2/internet-based-pecos/

Palmetto:http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~JM%20Part%20B~EDI~Enrollment~89BLL31745