Chiropractic Manipulative Treatment: Duplicate Denials

Denial Reason, Reason/Remark Code(s) 

• CO-18 - Duplicate Service(s): Same service submitted for the same patient, same date of service by
same doctor will be denied as a duplicate
• CPT codes: 98940, 98941, 98942

Resolution/Resources
First: Verify the status of your claim before resubmitting. You can determine the status of a claim through the Palmetto GBA Online Provider Services (OPS) tool or by calling the Palmetto GBA Interactive Voice Response (IVR) unit.

Online Claim Status Verification through OPS 

• All providers that have an EDI Enrollment Agreement on file may register to use this tool. If you haven’t already registered, please consider doing so.

• Access the introductory article to learn more by selecting the 'Introducing Online Provider Services' graphic on the top of any of our main contract Web pages

• Please note: Only one provider administrator per EDI Enrollment Agreement/per PTAN/NPI combination performs the registration process. The provider administrator can then grant permission to additional users related to that PTAN/NPI.

• Billing services and clearinghouses should contact their provider clients to gain access to the system
• Specific instructions for accessing claim status information through OPS are available in the OPS User Manual.

Please note:
• Only one chiropractic manipulative treatment will be allowed per day

Beneficiary Eligibility Denials

Denial Reason, Reason/Remark Code(s)
• PR-26: Expenses incurred prior to coverage
• PR-27: Expenses incurred after coverage terminated

Resolution/Resources: Verify patient eligibility prior to submitting claims to Medicare through the Palmetto GBA Online Provider Services (OPS) tool or Interactive Voice Response (IVR) unit.

Online Eligibility Verification through OPS

• All providers that have an EDI Enrollment Agreement on file may register to use this tool. If you haven't already registered, please consider doing so.

• Access the introductory article to learn more by selecting the 'Introducing Online Provider Services' graphic on the top of any of our main state Web pages

• Please note: Only one provider administrator per EDI Enrollment Agreement/per PTAN/NPI combination performs the registration process. The provider administrator can then grant permission to additional users related to that PTAN/NPI.

• Billing services and clearinghouses should contact their provider clients to gain access to the system
• Specific instructions for accessing beneficiary eligibility information through OPS are available in the OPS User Manual