Page 237 - Medicare Benefit Policy Manual

Information/MedicareApprovedFacilitie/ICR. All prospective ICR sites must apply to
enroll as an ICR program site using the designated forms as specified at 42 CFR 424.510,
and report specialty code 31 to be identified as an enrolled ICR supplier. For purposes of
appealing an adverse determination concerning site approval, an ICR site is considered a
supplier (or prospective supplier) as defined in 42 CFR 498.2.

CR and ICR Physician Standards:

Medical Director. Medical director means the physician who oversees the CR or ICR
program at a particular site. The medical director is the physician responsible for a CR or
ICR program and, in consultation with staff, is involved in directing the progress of
individuals in the program and must possess all of the following: (1) Expertise in the
management of individuals with cardiac pathophysiology. (2) Cardiopulmonary training
in basic life support or advanced cardiac life support. (3) Be licensed to practice medicine
in the State in which the CR or ICR program is offered.

Supervising Physician. Supervising physician means a physician that is immediately
available and accessible for medical consultations and medical emergencies at all times
items and services are being furnished to individuals under CR and ICR programs.
Physicians acting as the supervising physician must possess all of the following: (1)
Expertise in the management of individuals with cardiac pathophysiology. (2)
Cardiopulmonary training in basic life support or advanced cardiac life support. (3) Be
licensed to practice medicine in the State in which the CR or ICR program is offered.

(See Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part
1, section 20.10.1, Pub. 100-04, Medicare Claims Processing Manual, Chapter 32, section
140, Pub. 100-08, Medicare Program Integrity Manual, Chapter 10, section 10.2.2.5, for
CR and ICR claims processing, coding, and billing requirements.)

240 - Chiropractic Services - General
(Rev. 1, 10-01-03)
B3-2250, B3-4118

The term “physician” under Part B includes a chiropractor who meets the specified
qualifying requirements set forth in §30.5 but only for treatment by means of manual
manipulation of the spine to correct a subluxation.

Effective for claims with dates of services on or after January 1, 2000, an x-ray is not
required to demonstrate the subluxation.

Implementation of the chiropractic benefit requires an appreciation of the differences
between chiropractic theory and experience and traditional medicine due to fundamental
differences regarding etiology and theories of the pathogenesis of disease. Judgments
about the reasonableness of chiropractic treatment must be based on the application of
chiropractic principles. So that Medicare beneficiaries receive equitable adjudication of
claims based on such principles and are not deprived of the benefits intended by the law,