Wiki LCD/ NCD Group A,B,C,D Diagnosis Codes

[angela87165]

Hi!

I have been trying to find an answer but am having difficulty. The LCD (TX) L35424 (https://www.cms.gov/medicare-covera...Texas&CptHcpcsCode=98940&bc=gAAAACAAAAAAAA==&) for chiro code 98940 lists 3 sets of group codes. Each group (A, B, C, D) covers a different number of manipulations. I know that I have seen this in other LCD's. So, my question: In order for Medicare to pay for 30 manipulations per year, do you have to assign a group D diagnosis code, along with the subluxation primary code? I hope this makes sense.

Thank you for your time!

Angela Jones, CPC
(gotta say that I love having that CPC credential)

 

[danskangel313]

Hi!

I have been trying to find an answer but am having difficulty. The LCD (TX) L35424 (https://www.cms.gov/medicare-covera...Texas&CptHcpcsCode=98940&bc=gAAAACAAAAAAAA==&) for chiro code 98940 lists 3 sets of group codes. Each group (A, B, C, D) covers a different number of manipulations. I know that I have seen this in other LCD's. So, my question: In order for Medicare to pay for 30 manipulations per year, do you have to assign a group D diagnosis code, along with the subluxation primary code? I hope this makes sense.

Thank you for your time!

Angela Jones, CPC
(gotta say that I love having that CPC credential)

The link you posted directs to an LCD that's been superseded. Here's the current version: https://www.cms.gov/medicare-covera...Texas&CptHcpcsCode=98940&bc=gAAAACAAIAAAAA==&

Yes, 30 manipulations require a DX from group D (although payment is not guaranteed). There are subluxation codes listed in group D... are you not seeing those? Aside from the DX code, you also need to make sure the documentation is up to par according to the LCD as well.