Chiropractors: Updated CMS LCD now in effect; incorrectly denied claims will be reprocessed automatically

On Oct. 20, 2021, we were notified that the Centers for Medicare and Medicaid Services (CMS) updated its billing and coding guidelines for chiropractic services for Medicare products. The new guidelines went into effect on October 1, and we updated our systems on November 2, which is within the 30 days from notification allowed by CMS.

The new guidelines include coverage for the following diagnosis codes which weren’t previously covered:

  • M54.40 - Low back pain, unspecified
  • M54.59 - Other low back pain

Claims for these codes submitted between October 1 - November 2 that were incorrectly denied will be automatically reprocessed. Get more information on CMS’s article, “Billing and Coding: Chiropractic Services.”