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LICENSE FOR USE OF DENTAL PROCEDURE CODES, FOURTH EDITION ("CDT")

These materials contain Current Dental Terminology, (CDT), copyright Â© 2002, 2004 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

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This product includes CDT which is commercial technical data and/or computer data bases and/or commercial computer software, and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Dental Association, 211 East Chicago Avenue, Chicago, Illinois, 60611. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)(June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14(June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14(June 1987) and FAR 52.227-19(June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

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Departments

Treatment Plan for Chiropractic Manipulation Services

Comprehensive Error Rate Testing (CERT) review findings for insufficient documentation of chiropractic manipulation services are often due to the lack of a required treatment plan in the patient's medical record. The Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM), Benefit Policy Manual (Publication 100-02), Chapter 15, Section 240.1.2.2., Documentation Requirements - Initial Visit, further indicates that the treatment plan must include the following:

Recommended level of care (duration and frequency of visits)
Specific treatment goals; and
Objective measures to evaluate treatment effectiveness.

However, the presence of a treatment plan does not ensure Medicare benefits. Payment is not allowed for services documented as maintenance therapy. The IOM, Publication 100-02, Chapter 15, Section 30.5.B defines maintenance therapy as follows;

"Under the Medicare program, Chiropractic maintenance therapy is not considered to be medically reasonable or necessary, and is therefore not payable. Maintenance therapy is defined as a treatment plan that seeks to prevent disease, promote health, and prolong and enhance the quality of life; or therapy that is performed to maintain or prevent deterioration of a chronic condition. When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the chiropractic treatment becomes supportive rather than corrective in nature, the treatment is then considered maintenance therapy."

For additional Medicare billing and coverage guidelines, please visit our Chiropractic services web page. This information can be found by selecting the Resources tab in the top navigation bar, then Provider Specialties/Services.

Find more details of CERT errors assessed for chiropractic services on the "CERT Errors by Provider Specialty" report located on our CERT Error Analysis web page.

Page Last Updated: Wednesday, 05-Oct-2011 13:54:50 CDT