This policy describes Optum’s requirements for reimbursement of CPT codes 98940, 98941, 98942 (Spinal Chiropractic Manipulative Treatment) and 98943 (Extraspinal Chiropractic Manipulative Treatment). Medicare is establishing the following limited coverage for CPT/HCPCS codes 98940, 9892: At least as beneficial as an existing and available medically appropriate alternative.One that meets, but does not exceed, the patient’s medical need.Ordered and furnished by qualified personnel.Furnished in a setting appropriate to the patient’s medical needs and condition.Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member.Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is:.
Zero limits chiropractic trial#
Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000, which meet the requirements of the clinical trials NCD are considered reasonable and necessary).
Contractors shall consider a service to be reasonable and necessary if the contractor determines that the service is:
When appropriate, contractors shall describe the circumstances under which the proposed LCD for the service is considered reasonable and necessary under Section 1862(a)(1)(A). 100-08, Section 13.5.1, to be covered under Medicare, a service shall be reasonable and necessary.
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