Medicare Initial Treatment Date

When completing claims for most insurances, item 14 is for the date of onset – the date that the patient’s problem began and this date should be qualified with the qualifier 431 – Onset of Current Symptoms or Illness (The only other valid qualifier for item 14 is 484 – Last Menstrual Period)

And item 15 is used for ‘other date’. In this example, the date is qualified with 454 –  Initial Treatment

Example of non-Medicare insurance claim Eg: The patient was involved in an automobile accident on 08-17-18 but didn’t see the doctor until 08-22-18

However, for Chiropractic services reported to Medicare it is required to indicate the date of the initial treatment, or the date that the provider first saw the patient, made a diagnosis, and initiated the treatment plan for chiropractic care, in Item 14 on the CMS-1500 form.

Even though the current claim form includes a space for a qualifier, Medicare does not use this information; do not enter a qualifier in item 14 This can lead to claim rejections.

Also, item 15 should be left blank,

Example of a Chiropractic Medicare claim with the ‘initial treatment’ date in item 14 without qualifier and item 15 left blank

Instructions for the FormSmith Software Program

To turn on proper processing of block 14 and 15, edit the insurance company and click on the Form Completion tab then click the check box for “use initial treatment date in block 14 and 15 blank.”

Currently, CMS-1500 paper claims that include a qualifier in item 14 are being rejected/denied with the following rejection codes:

CO-16 – Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.)

MA130 – Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.

Medicare claims that are rejected as unprocessable do not meet the requirement to file the claim for the patient.

Electronic claims are not affected! The date of initial treatment is still reported in Loop 2300 | DTP.03 (454).

Just as a reminder, dates other than the date of birth (which must be in 8-digit format), can be in either 6-digit: (MM | DD | YY) or 8-digit: (MM | DD | CCYY) format. Intermixing the two formats on the claim is not allowed.

For more information reference the CMS Internet-Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 26 , Section 10.4