CodeMap® Report 98943
CodeMap® 




2018 ICD-10 Diagnosis Code Set Loaded     


10/01/2017 NCD Edits Loaded     


2017-D October DME Fee Schedule     


2017-A PEN Fee Schedule-no changes for rest of 2017     


2017-D October ASC Fee Schedule Updated     


2018-A October APC Fee Schedule Updated     


October 2017 ASP Drug Pricing Updated     


Q1 2018 CCI Edits Loaded     


Q1 2018 MUE Edits Loaded     


LCD Database Current Through 12/11/2017     

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98942
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98960

98943: CHIROPRACT MANJ XTRSPINL 1/>

CPT® 98943: Chiropractic manipulative treatment (CMT); extraspinal, 1 or more regions


Short Description: CHIROPRACT MANJ XTRSPINL 1/>

--

CPT copyright 2016 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

Unadjusted-National Fee Schedule Amount
ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Napa
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Yuba City
CALIFORNIA NORTH-San Francisco/Oakland/Hayward (Marin County)
CALIFORNIA NORTH-Vallejo/Fairfield
CALIFORNIA NORTH-Bakersfield
CALIFORNIA NORTH-Chico
CALIFORNIA NORTH-Fresno
CALIFORNIA NORTH-Hanford/Corcoran
CALIFORNIA NORTH-Madera
CALIFORNIA NORTH-Merced
CALIFORNIA NORTH-Modesto
CALIFORNIA NORTH-Redding
CALIFORNIA NORTH-Riverside/San Bernardino/Ontario
CALIFORNIA NORTH-Sacramento/Roseville/Arden/Arcade
CALIFORNIA NORTH-Salinas
CALIFORNIA NORTH-San Jose/Sunnyvale/Santa Clara (San Benito County)
CALIFORNIA NORTH-Santa Cruz/Watsonville
CALIFORNIA NORTH-Santa Rosa
CALIFORNIA NORTH-Stockton/Lodi
CALIFORNIA NORTH-Visalia/Porterville
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-El Centro
CALIFORNIA SOUTH-San Diego/Carlsbad
CALIFORNIA SOUTH-San Luis Obispo/Paso Robles/Arroyo Grande
CALIFORNIA SOUTH-Santa Maria/Santa Barbara
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State

2017 Physician
Fee Schedule:

Global Non-Facility Fee
Global Facility Fee
$ 27.63
$ 24.05


*Based on National 2013 Medicare Part B submitted claims.

2017 OPPS Status Indicator: E1

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
Percentage
ICD-10 Code
Description
Related DRG(s)
33.2%
M99.03
Segmental and somatic dysfunction of lumbar region
551-552
27.3%
M99.01
Segmental and somatic dysfunction of cervical region
551-552
5.4%
M99.02
Segmental and somatic dysfunction of thoracic region
551-552
4.4%
M99.06
Segmental and somatic dysfunction of lower extremity
555-556
4.1%
M99.04
Segmental and somatic dysfunction of sacral region
551-552
3.4%
M99.07
Segmental and somatic dysfunction of upper extremity
555-556
2.2%
M99.05
Segmental and somatic dysfunction of pelvic region
555-556
1.4%
M54.2
Cervicalgia
551-552
1.1%
M25.511
Pain in right shoulder
555-556
1.0%
M54.5
Low back pain
551-552

* Commonly Associated ICD-10 codes derived from CMS Q3 2016 Limited Data Set (LDS) claims data.
This data represents an analysis of 11,119,991 claims processed for 1,414,138 beneficiaries in the third quarter of 2016.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

98943 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 98943

CCI and MUE Edits*         Hide this section.

Column 1 CCI Edits for 98943
Denied Codes (1)
Effective
Modifier
Accepted (2)
36591 DRAW BLOOD OFF VENOUS DEVICE
10/01/2015 No
36592 COLLECT BLOOD FROM PICC
10/01/2015 No
99201 OFFICE/OUTPATIENT VISIT NEW
01/01/2006 Yes
99202 OFFICE/OUTPATIENT VISIT NEW
01/01/2006 Yes
99203 OFFICE/OUTPATIENT VISIT NEW
01/01/2006 Yes
99204 OFFICE/OUTPATIENT VISIT NEW
01/01/2006 Yes
99205 OFFICE/OUTPATIENT VISIT NEW
01/01/2006 Yes
99211 OFFICE/OUTPATIENT VISIT EST
01/01/2006 Yes
99212 OFFICE/OUTPATIENT VISIT EST
01/01/2006 Yes
99213 OFFICE/OUTPATIENT VISIT EST
01/01/2006 Yes
99214 OFFICE/OUTPATIENT VISIT EST
01/01/2006 Yes
99215 OFFICE/OUTPATIENT VISIT EST
01/01/2006 Yes
99217 OBSERVATION CARE DISCHARGE
01/01/2006 Yes
99218 INITIAL OBSERVATION CARE
01/01/2006 Yes
99219 INITIAL OBSERVATION CARE
01/01/2006 Yes
99220 INITIAL OBSERVATION CARE
01/01/2006 Yes
99221 INITIAL HOSPITAL CARE
01/01/2006 Yes
99222 INITIAL HOSPITAL CARE
01/01/2006 Yes
99223 INITIAL HOSPITAL CARE
01/01/2006 Yes
99231 SUBSEQUENT HOSPITAL CARE
01/01/2006 Yes
99232 SUBSEQUENT HOSPITAL CARE
01/01/2006 Yes
99233 SUBSEQUENT HOSPITAL CARE
01/01/2006 Yes
99234 OBSERV/HOSP SAME DATE
01/01/2006 Yes
99235 OBSERV/HOSP SAME DATE
01/01/2006 Yes
99236 OBSERV/HOSP SAME DATE
01/01/2006 Yes
99238 HOSPITAL DISCHARGE DAY
01/01/2006 Yes
99239 HOSPITAL DISCHARGE DAY
01/01/2006 Yes
99281 EMERGENCY DEPT VISIT
01/01/2006 Yes
99282 EMERGENCY DEPT VISIT
01/01/2006 Yes
99283 EMERGENCY DEPT VISIT
01/01/2006 Yes
99284 EMERGENCY DEPT VISIT
01/01/2006 Yes
99285 EMERGENCY DEPT VISIT
01/01/2006 Yes
99291 CRITICAL CARE FIRST HOUR
01/01/2006 Yes
99304 NURSING FACILITY CARE INIT
01/01/2006 Yes
99305 NURSING FACILITY CARE INIT
01/01/2006 Yes
99306 NURSING FACILITY CARE INIT
01/01/2006 Yes
99307 NURSING FAC CARE SUBSEQ
01/01/2006 Yes
99308 NURSING FAC CARE SUBSEQ
01/01/2006 Yes
99309 NURSING FAC CARE SUBSEQ
01/01/2006 Yes
99310 NURSING FAC CARE SUBSEQ
01/01/2006 Yes
99315 NURSING FAC DISCHARGE DAY
01/01/2006 Yes
99316 NURSING FAC DISCHARGE DAY
01/01/2006 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
99318 ANNUAL NURSING FAC ASSESSMNT
01/01/2006 Yes
99324 DOMICIL/R-HOME VISIT NEW PAT
01/01/2006 Yes
99325 DOMICIL/R-HOME VISIT NEW PAT
01/01/2006 Yes
99326 DOMICIL/R-HOME VISIT NEW PAT
01/01/2006 Yes
99327 DOMICIL/R-HOME VISIT NEW PAT
01/01/2006 Yes
99328 DOMICIL/R-HOME VISIT NEW PAT
01/01/2006 Yes
99334 DOMICIL/R-HOME VISIT EST PAT
01/01/2006 Yes
99335 DOMICIL/R-HOME VISIT EST PAT
01/01/2006 Yes
99336 DOMICIL/R-HOME VISIT EST PAT
01/01/2006 Yes
99337 DOMICIL/R-HOME VISIT EST PAT
01/01/2006 Yes
99341 HOME VISIT NEW PATIENT
01/01/2006 Yes
99342 HOME VISIT NEW PATIENT
01/01/2006 Yes
99343 HOME VISIT NEW PATIENT
01/01/2006 Yes
99344 HOME VISIT NEW PATIENT
01/01/2006 Yes
99345 HOME VISIT NEW PATIENT
01/01/2006 Yes
99347 HOME VISIT EST PATIENT
01/01/2006 Yes
99348 HOME VISIT EST PATIENT
01/01/2006 Yes
99349 HOME VISIT EST PATIENT
01/01/2006 Yes
99350 HOME VISIT EST PATIENT
01/01/2006 Yes
99455 WORK RELATED DISABILITY EXAM
01/01/2006 Yes
99456 DISABILITY EXAMINATION
01/01/2006 Yes
99460 INIT NB EM PER DAY HOSP
01/01/2009 Yes
99461 INIT NB EM PER DAY NON-FAC
01/01/2009 Yes
99462 SBSQ NB EM PER DAY HOSP
01/01/2009 Yes
99463 SAME DAY NB DISCHARGE
01/01/2009 Yes
99465 NB RESUSCITATION
01/01/2009 Yes
99466 PED CRIT CARE TRANSPORT
01/01/2009 Yes
99468 NEONATE CRIT CARE INITIAL
01/01/2009 Yes
99469 NEONATE CRIT CARE SUBSQ
01/01/2009 Yes
99471 PED CRITICAL CARE INITIAL
01/01/2009 Yes
99472 PED CRITICAL CARE SUBSQ
01/01/2009 Yes
99475 PED CRIT CARE AGE 2-5 INIT
01/01/2009 Yes
99476 PED CRIT CARE AGE 2-5 SUBSQ
01/01/2009 Yes
99477 INIT DAY HOSP NEONATE CARE
01/01/2008 Yes
99478 IC LBW INF < 1500 GM SUBSQ
01/01/2009 Yes
99479 IC LBW INF 1500-2500 G SUBSQ
01/01/2009 Yes
99480 IC INF PBW 2501-5000 G SUBSQ
01/01/2009 Yes
99483 ASSMT & CARE PLN PT COG IMP
01/01/2018 Yes
99485 SUPRV INTERFACILTY TRANSPORT
01/01/2013 Yes
99497 ADVNCD CARE PLAN 30 MIN
01/01/2016 Yes
G0463 Hospital outpt clinic visit
07/01/2014 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 98943.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.




2018 Medically Unlikely Edits for 98943


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: Not Listed Not Listed Not Listed
Adjudication Indicator: Not Listed Not Listed Not Listed
Rationale: Not Listed Not Listed Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.



   Medicare Part B Utilization Data for 98943*         Hide this section.



Annual Procedures - Tests Performed / Denied


Total National Services (all modifiers) Submitted 2016: 735,161
Total Services Denied 2016: 735,163 (100.0%)
National Charges Submitted 2016: $ 31,768,390.89
National Charges Allowed 2016: $ 0.00
National Average (No Modifier) Fee Submitted 2016: $ 45.29
National Average (No Modifier) Fee Allowed 2016: $ 0.00


Top 5 Performing Specialties 2016 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Chiropractic 731,789 99.5% $ 43.18 731,791 100.0%
Multispecialty clinic or group practice 2,466 0.3% $ 42.80 2,466 100.0%
Family practice 374 0.1% $ 77.35 374 100.0%
General practice 245 0.0% $ 53.39 245 100.0%
Nurse practitioner 60 0.0% $ 60.23 60 100.0%

Top 5 Places of Service 2016 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 733,512 99.8% $ 43.21 733,514 100.0%
Home 487 0.1% $ 57.29 487 100.0%
Outpatient hospital 118 0.0% $ 69.56 118 100.0%
Other unlisted facility 67 0.0% $ 32.18 67 100.0%

Top 5 Modifiers Submitted 2016 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
GY 299,375 40.7% $ 42.48 299,376 100.0%
No Modifier 212,719 28.9% $ 45.29 212,720 100.0%
AT 82,262 11.2% $ 44.19 82,262 100.0%
GA - Advanced Beneficiary Notice (ABN) on File 42,949 5.8% $ 42.84 42,949 100.0%
59 - Distinct Procedural Service 39,688 5.4% $ 43.45 39,688 100.0%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.



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