Billing and Coding: Chiropractic Services

This policy provides billing and coding guidance for chiropractic services: claims must include a valid ICD-10-CM diagnosis and, when applicable, the referring/ordering physician's name and NPI. Advance Beneficiary Notice rules apply: use GA/GX/GZ/GY modifiers as specified (GA requires a signed ABN or witnessed refusal and Part A MACs require occurrence code 32 and ABN date), and these modifiers generally cause automatic denials; medical records must contain assessment, history, test results, and signed, dated visit/operative documentation.

"A claim submitted without a valid ICD-10-CM diagnosis code will be returned as an incomplete claim under Section 1833(e) of the Social Security Act."

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