Page 238 - Medicare Benefit Policy Manual

A/B MACs (B) may use chiropractic consultation in A/B MAC (B) review of Medicare
chiropractic claims.

Payment is based on the physician fee schedule and made to the beneficiary or, on
assignment, to the chiropractor.

A. Verification of Chiropractor’s Qualifications

A/B MACs (B) must establish a reference file of chiropractors eligible for payment as
physicians under the criteria in §30.1. They pay only chiropractors on file. Information
needed to establish such files is furnished by the CMS RO.

The RO is notified by the appropriate State agency which chiropractors are licensed and
whether each meets the national uniform standards.

240.1 - Coverage of Chiropractic Services
(Rev. 1, 10-01-03)
B3-2251

240.1.1 - Manual Manipulation
(Rev. 1, 10-01-03)
B3-2251.1

Coverage of chiropractic service is specifically limited to treatment by means of manual
manipulation, i.e., by use of the hands. Additionally, manual devices (i.e., those that are
hand-held with the thrust of the force of the device being controlled manually) may be
used by chiropractors in performing manual manipulation of the spine. However, no
additional payment is available for use of the device, nor does Medicare recognize an
extra charge for the device itself.

No other diagnostic or therapeutic service furnished by a chiropractor or under the
chiropractor’s order is covered. This means that if a chiropractor orders, takes, or
interprets an x-ray, or any other diagnostic test, the x-ray or other diagnostic test, can be
used for claims processing purposes, but Medicare coverage and payment are not
available for those services. This prohibition does not affect the coverage of x-rays or
other diagnostic tests furnished by other practitioners under the program. For example,
an x-ray or any diagnostic test taken for the purpose of determining or demonstrating the
existence of a subluxation of the spine is a diagnostic x-ray test covered under
§1861(s)(3) of the Act if ordered, taken, and interpreted by a physician who is a doctor of
medicine or osteopathy.

Manual devices (i.e., those that are hand-held with the thrust of the force of the device
being controlled manually) may be used by chiropractors in performing manual
manipulation of the spine. However, no additional payment is available for use of the
device, nor does Medicare recognize an extra charge for the device itself.