(1) This rule applies to services that are provided from January 1, 2008, through June 30, 2011.
(2) Fees for services rendered by doctors of chiropractic are payable only for the procedure codes listed below and, unless otherwise specified, are payable according to the amounts allowed by the nonfacility fee schedule. The reimbursement rates referenced in the nonfacility fee schedule apply to diagnostic x-rays for services provided by doctors of chiropractic.
(3) Only the following codes may be billed for chiropractic services:
(a) all physical medicine and rehabilitation codes except:
(i) codes 97001 through 97006;
(ii) code 97033;
(iii) code 97532;
(iv) code 97533; and
(v) codes 97810 through 97814;
(b) special services, procedures, and report codes 99080, MT001, and HCPCS codes for supplies and materials. Code MT001 is described in ARM 24.29.1533. A separate written report must be submitted describing the service provided when billing for the codes identified in this subsection;
(c) chiropractic manipulative treatment codes 98940 through 98943;
(d) evaluation and management codes 99201 through 99204 and 99211 through 99214; and
(e) all diagnostic x-ray codes. The provider must furnish to the insurer documentation of the reasons justifying the use of the diagnostic x-ray procedure(s) employed.
(4) The explanations, protocols, comments, and directions for use contained in both the CPT manual and the nonfacility fee schedule are applied to the procedure codes contained in this rule.
(5) Code 97750 is payable for a maximum of 24 15-minute increments of service per day.
(6) Code 97150 is to be used when two or more injured workers are being treated in a group setting and all participants are engaged in the same therapeutic procedures under the direct supervision of a chiropractor. Documentation indicating the type of treatment and the number of participants in each session must be provided along with each bill.
(7) When a chiropractor is performing orthotics fitting and training (code 97760) or checking for orthotic/prosthetic use (code 97762), supplies and materials provided may be billed separately for each visit using the appropriate HCPCS code.