Noridian Medicare specifically regions JE California, Hawaii, Nevada, American Samoa, Guam and the Northern Mariana Islands. Region JF Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming. Have had all chiropractic claims denied improperly with a reason code of CO50, not medically necessary.
Noridian Medicare has notified Sam officially that this denial was an error on their end and they rectifying. Claims received prior to February 7, 2020, will have a mass adjustment and will reprocess within two weeks (the week of February 10, 2020). No need to rebill those claims. However, they are noting to hold new claims for an additional week until their system is fully updated.
Note that Noridian Medicare did retire the old Local Coverage Determination (LCD) L34242 with no new LCD at this time. There now is a Local Coverage Article: Billing and Coding: Chiropractor Services (A57913). This article does not list any specific diagnosis for chiropractic however, continue to use the same format as prior with a primary subluxation M99.00 to M99.05 and M99.10-M99.15 as well as a secondary neuromusculoskeletal diagnosis that substantiates the need for care. Note that documentation and medical necessity requirements for Medicare remain the same. This change in LCD was likely the issue.
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