Oklahoma Medicare-Chiropractic Services

Date:   03/28/2008

Due to Medicare’s conversion to Trailblazer a new LCD guideline (Local Coverage Determination)
became effective 3/1/08, that could result in claim rejections. The LCD contains Indications and
Limitations of Coverage and/or Medical Necessity. The information provided in the LCD is different
than the Chiropractic guidelines that were in place when Pinnacle Services processed claims.
Trailblazer may not recognize secondary diagnosis codes in Box 19. If you are submitting a print
image you can send up to four diagnosis codes, at least one of the four must be the secondary
(supporting) diagnosis code. If you have other secondary (supporting) diagnosis codes then make
sure you have documentation supporting the medical necessity of the service maintained in the
patient’s medical file and ready to submit to Medicare upon request.

If you are submitting the ANSI 837P format you can submit up to eight diagnosis codes

Provider Action:

If you are receiving remark codes *CO-50 and/or **N115 on your Medicare EOB or in the Electronic Remittance Advice file or you need more information please access the link below or contact Trailblazer Health customer service at 866-280-6520

http://www.trailblazerhealth.com/Tools/Local%20Coverage%20Determinations/Default.aspx?id=3025&DomainID=4

*CO-50 These are non-covered services because the payer does not deem this a “Medical Necessity”.
**N115 This information is based on a Local Medical Review Policy (LMRP) or Local Coverage Determination (LCD). A LMRP/LCD provides a guide to assist in determining whether a particular item or service is covered.