Tips to prevent claim adjustment reason code (CARC) PR 170
This denial is received when services furnished or ordered by a chiropractor are not related to treatment by means of manual manipulation of the spine to correct a subluxation and/or the claim submitted does not meet the requirements. Please refer to the chiropractic services billing and coding article for details.
Medicare coverage of chiropractic services is specifically limited to treatment by means of manual manipulation of the spine to correct a subluxation. All other diagnostic or therapeutic services furnished or ordered by a chiropractor are not covered by Medicare.
Per Medicare guidelines, claims for chiropractic services should include:
- Primary diagnosis = subluxation
- Secondary diagnosis = condition necessitating treatment
- All diagnosis codes must be coded to the highest level of specificity
- Date of initial visit or exacerbation of the existing condition
- Appropriate CPT code that best describes the service:
- 98940—Chiropractic manipulative treatment; spinal, one or two regions
- 98941—Spinal, three to four regions
- 98942—Spinal, five regions
- Modifier AT to indicate active / corrective treatment to treat acute or chronic subluxation, as applicable. Note: Documentation in the patient’s medical records must support that the service is reasonable and medically necessary.
- If you expect Medicare to deny the item or service (e.g. maintenance therapy) as not reasonable and necessary, you may include a modifier, as applicable. Refer to "How to use modifiers to indicate the status of an ABN" for additional information.
- GA—Signed Advanced Beneficiary Notice (ABN) on file
- GZ—Signed ABN not on file
- GY—Statutorily excluded
Resubmit the claim, if applicable: Make the necessary correction(s) and resubmit corrected line item(s) only. Resubmitting non-corrected line items will result in a duplicate claim denial. If a reopening request is applicable, you may submit your request via the SPOT or the interactive voice response (IVR).
Refer to SE1602 and SE1603 for information about proper modifier use and an overview of Medicare policies regarding chiropractic services.
Refer to the Chiropractic Services specialty page for additional information.
Reference