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Insurance Relations Committee

Insurance Relations Committee

Update 6-7-16

I have some exciting news to report regarding Medicaid and chiropractic services in SD.  For FY 2017, SD DSS has announced that not only has the standard annual increase of 2.7% been implemented, but they will be tiering our 9894X codes following Medicare standard.  Many thanks go to Dr. Scott Munsterman for his work in helping the DSS personnel understand this code set and why this change was necessary.  The codes will be reimbursed as follows:

98940    $16.94
98941    $24.39
98942    $31.85

This brings this set of codes into reasonable parity with how other disciplines (including disciplines such as PT, family practice and OB/GYN)  are reimbursed within Medicare.  I urge you all to BILL WHAT YOU DO and what is necessary.  Please don’t up or downcode.  If you have 5 regions of complaint and adjusted 5 regions and have it documented, use 98942.  This was  a point of contention in our talks with DSS over the years.  “You’re doctors are billing primarily 98940 so why should we change the structure?” was what we were fighting.  They now expect to see percentages of 98940:98941:98942 to fall reasonably in line with national averages.

The discussion then turned to examination structure.  Here, we are currently only allowed to bill the lowest level codes.  All others would be denied.  Based on the same logic as the 9894X codes, they will be looking at the fact that we actually and necessarily perform higher level examinations and should be allowed to bill for them.  This will be looked at for FY 2018.

We have been discussing reimbursement for modalities and extremities for quite some time.  SD DSS believed that under CMS regulations they were not allowed to pay for these service when provided by a DC.  They have provided the wording to us and we are currently looking to see how other states may have worked around this.  It appears there are 3 states that do pay for more than spinal adjustments.

I must admit that in my time on the Insurance Relations Committee, this may have been one of the single most productive meetings I have participated in.  It is important to realize that it took years of groundwork leading up to this one meeting though.  That is why our committee will keep the conversations with the payers going to Promote and Protect Chiropractic in South Dakota.

As always, if you have encountered a situation that you feel is not right, please contact me.  Without your input, the committee is forced to work only on our own experiences.  Knowing what is going on more broadly is so important to our work.

Dr. TJ Stotz
Vice President SDCA
(605) 661-3427


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