It has come to the attention of the NYSCA that some plan materials for certain 2026 Medicare Advantage (Part C) plans have included language that may appear confusing and contradictory.  We want to assure members that chiropractic spinal manipulation to correct a subluxation (active treatment) remains a covered service under all Medicare Advantage plans, consistent with Medicare Part B coverage.

ICD-10 applies to all parties covered by the Health Insurance Portability and Accountability Act (HIPAA), not just providers who bill Medicare or Medicaid. ICD10 diagnosis codes an updated every year. Improper coding will result in a claim denial. Remember, proper coding is essential for documentation, reporting and reimbursement.

National Government Services (NGS) wants to share with our providers an urgent issue that has been identified by the Centers for Medicare & Medicaid Services (CMS).

For additional information, please access this NYSCA Member's Only link:

Beginning 5/19/2025, there is a new mailing address for Medicare Part B claim submitters in Connecticut and New York (Upstate Counties and Queens). 

Last week Excellus BlueCross BlueShield and Univera Healthcare sent letters to their Medicare Advantage members receiving chiropractic care. The NYSCA Insurance Committee (NIC) has spoken with numerous NYSCA doctors regarding this notice and the impact on their practices.

If you participate with UnitedHealthcare / Optum you may have received notice of the change in the aforementioned prior authorization program.  Based upon the volume of calls, texts, and emails received by the NYSCA Insurance Committee (NIC), there has been several interpretations of the information published by UHC. For more information please access the following link:

UnitedHealthcare Updates

The 2025 Medicare Fee Schedule has been posted to the NGS Medicare website.

All Medicare providers and suppliers, including pharmacies, must not bill Medicare beneficiaries in the Qualified Medicare Beneficiary (QMB) eligibility group for Medicare Part A or Part B cost-sharing. This includes Medicare Part A and Part B deductibles, coinsurance, and copayments.

Read More: MLN Matters Fact Sheet October 2024

Starting today 11/18/2024, healthcare providers won’t have access to beneficiary eligibility information on the NGS Medicare interactive voice response (IVR) system. This includes all beneficiary eligibility information that was obtained under Option 1, Eligibility. The IVR will continue to offer the other non-eligibility transactions.

Beginning Jan. 1, 2025, the $15 copayment for the EmblemHealth-GHl portion of the Senior Care Plan will resume. Senior Care members will be required to pay a $15 copay each time they use the health services listed below. Copays are limited to one copay per provider per date of service.

Every year there are updates to the ICD-10 codes. Listed below please find the codes most relevant to the Chiropractic profession per the cms.gov website. These changes take effect 10/1/2024. 

Effective August 29, 2024, Humana is requiring prior authorization of certain Medicare Advantage members for chiropractic manipulative therapy rendered on or after August 29, 2024. The NYSCA Insurance Committee (NIC) reached out to Humana over the past week to ascertain whether prior authorization was required for Humana Medicare Advantage members in New York.

The NYSCA continues to communicate with Optum regarding the implementation of the new prior authorization program for AARP and UnitedHealthcare's Medicare Advantage members. We understand many of you have been attempting to determine the impact of this requirement on your practice and the patients you serve.  

On Thursday August 1st many of you received UnitedHealthcare's Provider News email.  That edition of Provider News included a section titled 'Outpatient therapy and chiropractic prior authorization required starting Sept. 1'.  Due to the lack of clarity in that email, the NIC reached out to several members of Optum's team Thursday morning and afternoon to obtain more specific information about the new requirement.

On March 4, 2024, the U.S. Department of Health & Human Services (HHS) through the Centers for Medicare & Medicaid Services (CMS) published a notice in the Federal Register that clarifies changes to the data elements providers must submit to the National Plan and Provider Enumeration System (NPPES) to obtain and maintain a National Provider Identifier (NPI).

According to the 2024 Medicare Physician Payment Schedule (MPFS), chiropractors are experiencing a 5.37 MPFS percent cut this year.  

In mid-Summer 2021, the NYSCA issued a memorandum in response to a question about whether chiropractors as merchants could levy a surcharge on a patient who used her credit card to pay for her deductible, copayment or visit charge in order to offset the credit card companies processing fees often referred to as “swipe fees.”

On Wednesday, November 29, 2023 NGS Medicare released a statement that the calendar year (CY) 2024 Medicare Physician Fee Schedule (MPFS) is now available. You can view the new fees using the Fee Schedule Lookup tool located on NGSMedicare.com.

On October 12, 2023, the Centers for Medicare & Medicaid Services (CMS) released the 2024 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2024 Medicare Part D income-related monthly adjustment amounts.