Medicare ICD-10 Update and Information on EmblemHealth Medicare

As of 10/1/2015 the following ICD-10 codes are required by Medicare as the primary diagnosis.

In ICD-10 this will come from the M99 series of codes:

  • M99.01 segmental and somatic dysfunction cervical region  
  • M99.02 segmental and somatic dysfunction thoracic region  
  • M99.03 segmental and somatic dysfunction lumbar region 
  • M99.04 segmental and somatic dysfunction sacral region 
  • M99.05 segmental and somatic dysfunction pelvic region

There is no longer a required list of secondary codes. It is our understanding that all neuromusculoskeletal codes available within our scope of practice under ICD-10 may be utilized. NYSCA will be monitoring changes in Medicare and the LCD as well as ICD-10 coding trends. Keep an eye out for periodic updates.

EmblemHealth Medicare: It has come to our attention that Emblem Health Medicare is either denying services or requesting refunds for services already paid if the –AT modifier is not appended to the CMT code to denote active treatment as with regular Medicare. If you have received a request for a refund for services paid contact EmblemHealth Medicare Provider Relations for instructions on the proper form to fill out to allow your claims to be correctly coded and reprocessed. These requests for refunds have gone back as far as December 2013. Going forward please be advised to use the –AT modifier for active treatment when utilizing CMT codes for Emblem Health Medicare.

The provider manual for EmblemHealth Medicare can be found here.


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