Page 244 - Medicare Benefit Policy Manual

Malignancies that involve the vertebral column;

Infection of bones or joints of the vertebral column;

Signs and symptoms of myelopathy or cauda equina syndrome;

For cervical spinal manipulations, vertebrobasilar insufficiency syndrome; and

A significant major artery aneurysm near the proposed manipulation.

240.1.4 – Location of Subluxation
(Rev. 1, 10-01-03)
B3-2251.4

The precise level of the subluxation must be specified by the chiropractor to substantiate
a claim for manipulation of the spine. This designation is made in relation to the part of
the spine in which the subluxation is identified:

Number of Short Form or
Area of Spine Names of Vertebrae Vertebrae Other Name

Neck Occiput 7 Occ, CO

Cervical C1 thru C7

Atlas C1

Axis C2

Back Dorsal or 12 D1 thru D12

Thoracic T1 thru T12

Costovertebral R1 thru R12

Costotransverse R1 thru R12

Low Back Lumbar 5 L1 thru L5

Pelvis IIii, r and 1 I, Si

Sacral Sacrum, Coccyx S, SC

In addition to the vertebrae and pelvic bones listed, the Ilii (R and L) are included with
the sacrum as an area where a condition may occur which would be appropriate for
chiropractic manipulative treatment.