Section 471-5-004 - BILLING AND PAYMENT FOR CHIROPRACTIC SERVICES004.01BILLING.004.01(A)GENERAL BILLING REQUIREMENTS. Providers must comply with all applicable billing requirements codified in 471 NAC 3. In the event that individual billing requirements in 471 NAC 3 conflict with billing requirements outlined in this chapter, the individual billing requirements in this chapter will govern. 004.01(B)SPECIFIC BILLING REQUIREMENTS.004.01(B)(i)BILLING INSTRUCTIONS. The provider must bill Medicaid, using the appropriate claim form or electronic format.004.01(B)(ii)USUAL AND CUSTOMARY CHARGE. The provider, or the provider's authorized agent, must submit the provider's usual and customary charge for each procedure code listed on the claim. Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) procedure codes used by Medicaid are listed in the Nebraska Medicaid Practitioner Fee Schedule.004.01(B)(iii)CHIROPRACTIC TREATMENT. The chiropractor must list the following information on the claim when billing Medicaid: (1) The diagnosis which includes the level of subluxation;(2) The symptom(s) that directly relates to the diagnosis of subluxation; and(3) The initial date of treatment billed to Medicaid for the reported diagnosis.004.02PAYMENT.004.02(A)GENERAL PAYMENT REQUIREMENTS. Medicaid will reimburse the provider for services rendered in accordance with the applicable payment regulations codified in 471 NAC 3. In the event that individual payment regulations in 471 NAC 3 conflict with payment regulations outlined in this chapter, the individual payment regulations in this chapter will govern.004.02(B)SPECIFIC PAYMENT REQUIREMENTS.004.02(B)(i)REIMBURSEMENT. Medicaid pays for covered chiropractic services in the amount equal to the lesser of: (1) The provider's submitted charge; and(2) The allowable amount for that procedure code in the Nebraska Medicaid Practitioner Fee Schedule in effect for the date of service.471 Neb. Admin. Code, ch. 5, § 004
Amended effective 9/19/2020