Page 239 - Medicare Benefit Policy Manual

Effective for claims with dates of service on or after January 1, 2000, an x-ray is not
required to demonstrate the subluxation. However, an x-ray may be used for this purpose
if the chiropractor so chooses.

The word “correction” may be used in lieu of “treatment.” Also, a number of different
terms composed of the following words may be used to describe manual manipulation as
defined above:

• Spine or spinal adjustment by manual means;

• Spine or spinal manipulation;

• Manual adjustment; and

• Vertebral manipulation or adjustment.

In any case in which the term(s) used to describe the service performed suggests that it
may not have been treatment by means of manual manipulation, the A/B MAC (B)
analyst refers the claim for professional review and interpretation.

240.1.2 - Subluxation May Be Demonstrated by X-Ray or Physician’s
Exam
(Rev. 1, 10-01-03)
B3-2251.2

Subluxation is defined as a motion segment, in which alignment, movement integrity,
and/or physiological function of the spine are altered although contact between joint
surfaces remains intact.

A subluxation may be demonstrated by an x-ray or by physical examination, as described
below.

1. Demonstrated by X-Ray

An x-ray may be used to document subluxation. The x-ray must have been taken at a
time reasonably proximate to the initiation of a course of treatment. Unless more specific
x-ray evidence is warranted, an x-ray is considered reasonably proximate if it was taken
no more than 12 months prior to or 3 months following the initiation of a course of
chiropractic treatment. In certain cases of chronic subluxation (e.g., scoliosis), an older
x-ray may be accepted provided the beneficiary’s health record indicates the condition
has existed longer than 12 months and there is a reasonable basis for concluding that the
condition is permanent. A previous CT scan and/or MRI is acceptable evidence if a
subluxation of the spine is demonstrated.

2. Demonstrated by Physical Examination