Manipulation Services
Defines how Premera applies limits and billing rules for chiropractic manipulative treatment (CMT), osteopathic manipulative treatment (OMT), and related physical medicine therapeutic services for professional claims submitted on CMS-1500 or 837P. Applies to Premera and affiliated products.
No material clinical or coverage changes in this revision.
Manipulation Services Coverage Criteria
Manipulation services coverage criteria
Coverage and billing rules for manipulation services and related therapeutic and E&M services.
ALL of the following
- One spinal CPT code (covers one or more spinal regions) AND one extraspinal CPT code may be reported per patient per provider per day
One unit per reported code, per provider, per patient, per day
- CMT codes include pre-manipulative assessment, intra-service work, and all post-service work
E&M interaction — CMT
- Per CMS NPFS, CMT procedure codes are considered minor procedures; an E&M service on the same date of service is generally included in the procedure reimbursement and is not reported separately
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