Wednesday, June 9, 2010

Denial code CO PR 170

CO 170  This payment is adjusted when performed/billed by this type of provider.

Tips for avoiding this denial :

Chiropractors’ services extend only to treatment by means of manual manipulation of the spine to correct a subluxation. All other services furnished or ordered by chiropractors are not covered.

Tip to correct the denied claim :

Services not covered by Medicare should not be billed to Medicare.
Billing denied services to Medicare for coordination of benefits is allowable.

This type of provider can't be performed this service hence please check the procedure CPT code and change it if any mistakes happened or else we it should be adjustment.

If our provider keep on doing this procedure means, contact insurance and include this procedure CPT code in the contract.

Other possibilities for this denial

This revenue code cannot be paid to this provider type. Please verify the accuracy of revenue code, provider number, and claim form used in billing. Resubmit on the correct claim form with

X-Rays: Denied for Chiropractors

Denial Reason, Reason/Remark Code(s)

PR-170: Payment is denied when performed/billed by this type of provider

CPT codes: 70000 through 79999


Medicare coverage of services performed by chiropractors is limited to treatment by means of manual manipulation of the spine to correct a subluxation, provided such treatment is legal in the state where performed. All other services furnished or ordered by chiropractors are not covered.

If a chiropractor orders, takes or interprets an X-ray or other diagnostic procedure to demonstrate a subluxation of the spine, the X-ray can be used for documentation. However, there is no coverage or payment for these services or for any other diagnostic or therapeutic service ordered or furnished by the chiropractor. 

Services such as office visits (evaluation and management services), diagnostic studies, physical therapy and other services rendered by chiropractors are not required to be submitted for coverage consideration by the Medicare program. The Centers for Medicare & Medicaid Services (CMS) does not require providers to submit claims for services that are excluded by statute under Section 1862(a) (1) of the Social Security Act. If a Medicare beneficiary believes a service may be covered or requests a formal Medicare determination for consideration by a supplemental plan, the provider must submit a claim.

To submit a claim for a non-covered service by a chiropractor, use HCPCS modifier GY to indicate that the service is statutorily excluded from coverage

You may submit both covered and non-covered services on the same claim

Submitting Non-covered Services for Denial Purposes

If you are submitting a non-covered service to Medicare for denial purposes, the service may be submitted with HCPCS modifier GY. This modifier lets us know that an item or service is statutorily excluded or does not meet the definition of any Medicare benefit.

CMS has developed new Advance Beneficiary Notice (ABN) forms. The new forms incorporate the 'old' Notice of Exclusion from Medicare Benefits (NEMB) language and may be used right away. Use of the revised ABN is optional for services that are excluded from Medicare benefits. Access revised ABN and other background information from the CMS website external link .

If you have obtained a valid ABN for excluded services for services provided on or after March 1, 2009, submit claims for this service with HCPCS modifier GY. Refer to the Palmetto GBA Modifier Lookup Tool for information on HCPCS modifier GY.

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