(1) Except as otherwise provided by this rule, fees for medical specialty area services rendered by chiropractors from April 1, 1993 through June 30, 2002 are payable only for the procedure codes listed below, according to the unit values listed. None of the procedure codes, descriptions, or unit values in Relative Values for Physicians apply to chiropractic services other than diagnostic x-rays.

(2) Nothing in this rule is to be construed so as to broaden the scope of a provider's practice. Each provider is to limit their services to those which can be performed within the limits and restrictions of the provider's professional licensure. Providers may only charge for services performed that are consistent with the scope of their practice and licensure.

(3) The conversion factor used depends on the date the service was rendered:

(a) Effective April 1, 1993, the conversion factor for services, other than diagnostic x-rays, performed by a doctor of chiropractic within the scope of practice is $3.77.

(b) Effective April 1, 1993, the conversion factor for diagnostic x-rays is $15.59.

(c) Effective January 1, 1994, and each year annually thereafter, the conversion factors will increase in the manner specified by ARM 24.29.1536.

(4) The following special procedure codes, with the associated description and unit values, are recognized for chiropractic services:

 

	Procedure Code	Description	Unit Value
(a)	C9201	Brief Consultation and Examination New Patient. This examination includes a brief history of the problem only, as well as inspection of the problem area, not including orthopedic and/or neurological testing. Very straightforward chiropractic decision-making involved. This is usually a self-limited or minor problem.	5.2
(b)	C9202	Limited Consultation and Examination New Patient. This includes an expanded, problem focused history with documentation of chief complaints, and nature of injury. An expanded, problem focused examination would include documentation of at least two of the following: Inspection, range of motion, palpatory findings, appropriate orthopedic tests, muscle strength, sensory tests, reflexes, mensuration. Presenting problems are usually of low to moderate severity involving straightforward chiropractic decision making.	7.6
(c)	C9203	Intermediate Consultation and Examination New Patient. This includes documentation of a detailed history of chief complaints, nature of injury and past history including pre-existing conditions. A detailed examination should include documentation of at least three of the following: Inspection, range of motion, palpatory findings, appropriate orthopedic tests, muscle strength, sensory test, reflexes, mensuration. Presenting problems are usually of moderate severity involving chiropractic decision making of low complexity.	11.2
(d)	C9204	Extended Consultation and Examination New Patient. This includes documentation of a comprehensive history of chief complaints, nature of injury and past history, including pre-existing conditions. A comprehensive examination should include documentation of at least four of the following: Inspection, range of motion, palpatory findings, appropriate orthopedic tests, muscle strength, sensory tests, reflexes, mensuration. Presenting problems are usually of moderate to high severity involving chiropractic decision making of moderate severity. Procedure includes preparation of short narrative and findings.	16.0
(e)	C9205	Comprehensive Consultation and Examination, New Patient. This includes documentation of a comprehensive history of chief complaints, nature of injury and past history, including pre-existing conditions. A comprehensive examination should include documentation of at least five of the following: Inspection, range of motion, palpatory findings, appropriate orthopedic tests, muscle strength, sensory tests, reflexes, mensuration. Presenting problems are usually of moderate to high severity involving chiropractic decision making of high complexity. Procedure includes preparation of short narrative and findings.	20.8
(f)	C9211	Brief Office Visit for Evaluation and Management, Established Patient. May not require the presence of a physician. Presenting problems are usually minimal and typically five minutes or less are spent performing or supervising these services	2.8
(g)	C9212	Limited Office Visit For Evaluation and Management, Established Patient. This includes at least two of the following three key components: (i) A problem focused history. (ii) A problem focused examination, including documentation of at least two of the following: Inspection, range of motion, palpatory findings, appropriate orthopedic tests, muscle strength, sensory tests, reflexes, mensuration. (iii) Straightforward chiropractic decision making. Usually, presenting problems are self limited or minor.	4.8
(h)	C9213	Intermediate Office Visit for Evaluation and Management, Established Patient. This includes at least two of the following three key components: (i) An expanded, problem focused history. (ii) An expanded, problem focused examination, including documentation of at least three of the following: Inspection, range of motion, palpatory findings, appropriate orthopedic tests, muscle strength, sensory tests, reflexes, mensuration. (iii) Chiropractic decision making of low complexity. Usually presenting problems are of low to moderate severity.	7.8
(i)	C9214	Extended Office Visit for Evaluation and Management, Established Patient. This includes at least two of the following three key components: (i) A detailed history. (ii) A detailed examination including documentation of at least four of the following: Inspection, range of motion, palpatory findings, appropriate orthopedic tests, muscle strength, sensory tests, reflexes, mensuration. (iii) Chiropractic decision making of moderate complexity. Usually presenting problems are of moderate to high severity. Procedure includes preparation of short narrative and findings.	11.6
(j)	C9215	Comprehensive Office Visit for Evaluation and Management, Established Patient. This includes at least two of the following three key components: (i) A comprehensive history. (ii) A comprehensive examination, including documentation of at least five of the following: Inspection, range of motion, palpatory findings, appropriate orthopedic tests, muscle strength, sensory tests, reflexes, mensuration. (iii) Chiropractic decision making of high complexity. Usually, presenting complaints are of moderate to high severity. Procedure includes preparation of short narrative and findings.	17.6
(k)	C9251	Manipulation only, single area of spine (includes C9211 office visit).	5.5
	C9252	Manipulation only, two or more areas of spine (includes C9211 office visit).	8.2
	C9253	Manipulation only, single area of spine, when billed with an office visit, C9201 - C9215.	2.7
(l)	C9261	One of the following modalities, w/o manipulation (includes a C9211 office visit): (i) hot or cold packs, (ii) traction, mechanical, (iii) electrical stimulation, (iv) vasopneumatic devices, (v) paraffin bath, (vi) microwave, (vii) whirlpool, (viii) diathermy, (ix) infrared, (x) ultraviolet, (xi) other.	3.8
	C9262	Two or more modalities, w/o manipulation (includes C9211 office visit).	4.8
	C9263	One modality, w/o manipulation, when billed with an office visit, C9201 - C9215.	1.0
	C9264	Two or more modalities, w/o manipulation, when billed with an office visit, C9201 - C9215.	2.0
(m)	C9271	Manipulation, single area of spine, w/ two or more modalities (consists of C9211 office visit, C9253 and C9264).	7.5
	C9272	Manipulation, two or more areas of spine, w/two or more modalities (consists of C9211 office visit, C9253 and C9264).	10.2
	C9273	Manipulation, one or more areas, w/ two or more modalities, when billedwith office visit C9201 - C9215.	4.7
(n)	C9399	Special reports, service not listed (includes impairment ratings).	BR

       

(5) For initial visits, if it is necessary to provide intermediate, extended or comprehensive services as part of the initial evaluation process (codes C9203, C9204 or C9205), the provider must furnish to the insurer documentation of the reasons justifying that higher level of initial evaluation.

(6) For routine follow-up visits of an established patient, only the "brief office visit" level of service (code C9211) should be billed. If limited, intermediate, extended or comprehensive services are necessary (codes C9212, C9213, C9214 or C9215), the provider must furnish to the insurer documentation of the reasons justifying that higher level of office visit on a case-by-case, visit-by-visit basis.

(7) Diagnostic x-rays are to be billed using the procedure codes and unit values listed in Relative Values for Physicians. The provider must furnish to the insurer documentation of the reasons justifying the use of the diagnostic x-ray procedure(s) employed.

(8) The explanations, protocols, comments and directions for use contained in both the CPT manual and Relative Value for Physicians are to be applied to the procedure codes contained in this rule.