Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES
Chapter 5 - CHIROPRACTIC SERVICES
Section 471-5-004 - BILLING AND PAYMENT FOR CHIROPRACTIC SERVICES
Universal Citation: 471 NE Admin Rules and Regs ch 5 ยง 004
Current through September 17, 2024
004.01 BILLING.
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.
004.02 PAYMENT.
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.
Disclaimer: These regulations may not be the most recent version. Nebraska may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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