IACP

Medicaid / Medicare Information

Chiropractic Services Under Medicare 

According to the US Center for Medicare and Medicaid Services (CMS), Medicare Part B (Medical Insurance) covers manipulation of the spine if medically necessary to correct a subluxation when provided by a chiropractor or other qualified provider.  There are significant paperwork requirements, as well as, potential audit requirements that must be followed.  Review the CMS overviews below for more information. 

Medicare

Medicare Coverage for Chiropractic Services – Medical Record Documentation Requirements for Initial and Subsequent Visits 
Misinformation on Chiropractic Services  CMS fact sheet to correct misinformation in the chiropractic community
Medicare Benefit Policy Manual - CMS Update 3/11/16
Medicare Claims Processing Manual - CMS Update 3/16/16
Medicare Active Treatment Modifier Guidance - Use of the AT modifier for Chiropractic Billing (MM3449 - CMS Update)

PQRS Medicare Update - 2015 Update
ACA PQRS Guidebook - 2015 Update

Coverage of chiropractic services is specifically limited to treatment by means of manual manipulation (i.e., by use of the hands) of the spine to correct a subluxation. 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.

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. 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. If you order, take, or interpret an x-ray, or any other diagnostic test, the x-ray or other diagnostic test can be used for documentation, but Medicare coverage and payment are not available for those services. This does not affect the coverage of x-rays or other diagnostic tests furnished by other practitioners under the program.

Chiropractic Services Under Idaho Medicaid 

Medicaid

Idaho Medicaid Idaho MMIS Provider Handbook – Chiropractic Overview for Medicaid Services in Idaho
Idaho Medicaid Covered Services  Covered Medicaid Services Under the Idaho Medicaid Program
Idaho Administrative Rules Related to Covered Health Care Services (IDAPA) - Update 2013


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