Access the Medicare Coverage Database for More Details.

The MCD is pretty much a centralized repository for all of Medicare’s billing and coverage information. It’s where you find the LCDs, the NCDs, the billing articles we have to stay abreast of.

Search for “chiropractic”. That brings up all of the forms for billing chiropractic. For instance, you’ll notice:

• Chiropractic Services (L34462)
• Chiropractic Services – Temperature Gradient Studies (L35090)
• Billing and Coding: Chiropractic Services (A57465)

Take your time reading through these, particularly that first one.

The LCDs tell you the entire script for what Medicare will cover. And they include forms and bills you’ll need to settle claims.

Search For Codes Billing & Coding Articles

Note: A 2021 change you should know is that all of the procedure and diagnosis codes have migrated out of the LCDs and into Billing & Coding Articles by Medicare.

So what does this tell you?

If you need codes for chiropractic services refer to the Billing & Coding Article A57465. The LCD L34462 will keep all of the other coverage information.

Coding such as ICD-10 diagnoses, revenue codes, and billing type linger in the LCDs, however. So go double check to see the codes you need there!

How Does National Coverage Decisions Impact Chiropractic?

LCDs are local regulations, but NCDs are national coverage guidelines for Medicare on the entire country.

To chiropractic, the big one is: Chiropractor’s (150.5)

The NCDs aren’t going to contain billing information, such as codes. Mostly just say they’re saying Medicare is going to or won’t pay something. So, to know exactly how to bill for something in an NCD, read Change Requests and the Medicare claims processing guide.

Check for Claims Processing Updates

Every time a chiropractor changes an NCD or LCD, Medicare sends a Change Request (CR). These CRs explain the impact of the change on the claims system.

New CRs are SO super important to follow, so you can bill as stuff comes out. You don’t want claims dismissed because you missed a memo!

Check out the latest CRs frequently to keep billing and codes up to date. This avoids later headaches.

Find Information Quickly with MCD Search

There is nothing fun about having to look under thick LCDs for one piece of information. This is where the MCD Search helps you!

You just enter a CPT number such as 98940, select your state and search. It’ll bring up the Billing & Coding Article, and it will contain all usage and coverage details for that particular code. More efficiently than a 50 page LCD!

You can even search for patient Medicare card information to receive submission instructions for that beneficiary. This is critical to determining why a claim was rejected.

Contact Contractors for Clarification

Even people who have ever invoiced Medicare are still confused on occasion. That’s when you want to get to the people – the contractors!

Each MCD includes contact information (generally your Medicare Administrative Contractor or MAC). If an LCD or CR just doesn’t make any sense, phone them or e-mail them.

The contractors will have an explanation of cryptic policies and billing advice for you. And don’t be shy about asking them to assist! That’s why they are here.

Solutions to Denials with MCD Search

Negations are painful — but not to worry! Rely on denial letters to identify the issue.

See the MCD for the billed codes/denial reasons. Check your policies to see how your claim veered off course. Perhaps a code doesn’t exist for that diagnosis or maybe a modifier is unavailable.