The chiropractic local coverage determinations (LCDs) for MACs include ICD-10 coding Information for ICD-10 codes that support the medical necessity for chiropractor
services. There may be additional documentation information in your LCD. There are links to the chiropractic LCDs in the Additional information section of this article.
The group 1 (primary) codes are the only covered ICD-10-CM codes that support medical necessity for chiropractor services.
*** Primary: ICD-10-CM codes (names of vertebrae)
*** The precise level of subluxation must be listed as the primary diagnosis.
The groups 2, 3, and 4 ICD-10-CM codes support the medical necessity for diagnoses and involve short, moderate, and long term treatment:
*** Group 2 codes: Category I – ICD-10-CM diagnosis (diagnoses that generally require short-term treatment)
*** Group 3 codes: Category II – ICD-10-CM diagnosis (diagnoses that generally require moderate-term treatment)
*** Group 4 codes: Category III – ICD-10-CM diagnosis (diagnoses that may require long-term treatment) ICD-10 codes that do not support medical necessity are all ICD-10-CM codes not listed in LCDs under ICD-10-CM codes that support medical necessity.
Additional information
If you have any questions, please contact your MAC at their toll-free number. That number is available at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/index.html under – How Does It Work.
