Originally Posted On: Medicare and Chiropractic: How much does Medicare cover? – (trustedbenefitsdirect.com)
I found an article from a local news station in Southern Illinois discussing Medicare’s coverage of chiropractic services. The title is Bill Would Increase Medicare Coverage of Chiropractic Services by Joe Ragusa. The article discusses a bill introduced in the House of Representatives to expand coverage under Medicare for chiropractic services. This article is very short with very little details, however, our blog article will at least attempt to provide some more additional details.
How much does Original Medicare cover for chiropractic services now?
The short answer to this is very little. The first and best place to look for many questions to what Medicare covers is looking at the official handbook of Medicare called Medicare and You. In the 120 page document, there is mention of chiropractic services in two short paragraphs on page 33. What Medicare and You states is, “Medicare covers manipulation of the spine if medically necessary to correct a subluxation (when one or more of the bones of your spine move out of position) when provided by a chiropractor or other qualified provider.” That is all Medicare covers under chiropractic services. Medicare and You goes on to note “Medicare doesn’t cover other services or tests ordered by a chiropractor, including X-rays, massage therapy, and acupuncture.” The term “by a chiropractor” is a very important term when getting X-rays and other chiropractic services covered.
If a Medicare beneficiary does have chiropractic services covered they are covered under Part B of Medicare. The beneficiary will be responsible for the once per calendar year Part B deductible ($185 in 2019) and 20% coinsurance. A Medicare Supplement plan also known as a Medigap plan may have coverage to pay all or part of the Part B deductible and Part B 20% coinsurance. Medicare Supplement plans that offer coverage to pay the Part B deductible are Plans C and F. Plan K pays 50% of the Part B 20% coinsurance, Plan L pays 75%, Plans A, B, C, D, F, G, M pay 100%, and Plan N pays 100% of the Part B coinsurance except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission. For more information about Medicare Part B, please refer to our blog post https://trustedbenefitsdirect.com/what-is-medicare-part-b/ and our Medicare Part B Video.
Medicare Advantage and Chiropractic Coverage
Currently, Original Medicare has a very limited scope of coverage for chiropractic services only covering for manipulation of the spine. A Medicare Advantage plan, a replacement of Original Medicare by private insurance may have additional coverage for chiropractic services. If a Medicare beneficiary would like to have a Medicare Advantage plan from a private insurance company instead of Original Medicare we recommend they do much research on the plan they are looking at. Medicare Advantage can be very tricky and has many different rules from Original Medicare. The Medicare beneficiary may be adding coverage as compared to Original Medicare, but also may be limiting the providers they can see for their regular medical needs. The beneficiary would benefit from the use of a service like ours that represents many Medicare Advantage plans and many Medicare Supplement plans as independent agents to get the full picture to see exactly what is right for each Medicare beneficiary.
A Chiropractor’s Thoughts about Medicare and Chiropractic Coverage
Mr. Ragusa quotes in his article Dr. Brad Miller as saying “one of the things that are not covered by Medicare is the exam and any diagnostics. The challenge is, in order for us to have a working diagnosis, we have to do those services, and Medicare actually requires us to do those services to our patients.” When looking at this quote it says Medicare requires the chiropractor to do services to patients that are not covered by Medicare, for example, exam and diagnosis services to conclude a Medicare-covered subluxation is needed. As we see there is not much coverage for chiropractic service with Original Medicare.
What Medicare doesn’t cover under Chiropractic
According to the Centers’ for Medicare and Medicaid Services (CMS) billing and coding guidelines: CHIRO-001 – under the section titled Non-Covered Services:
“All services other than manual manipulation of the spine for treatment of subluxation of the spine are excluded when ordered or performed by a doctor of chiropractic. Chiropractors are not required to bill these to Medicare. Chiropractic offices may want to submit charges to Medicare to obtain a denial necessary for submitting to a secondary insurance carrier. The following are examples of (not an all-inclusive list) of services that, when performed by a Chiropractor, are excluded from Medicare coverage.”- -Laboratory tests- X-rays- Office Visits (history and physical)- Physiotherapy- Traction- Supplies- Injections- Drugs- Diagnostic studies including EKGs- Acupuncture- Orthopedic devices- Nutritional supplements and counseling
CMS Chiropractic Billing and Guidelines: https://trustedbenefitsdirect.com/wp-content/uploads/2019/09/Chiropractic-Billing-and-Coding-Guidelines.pdf
How H.R. 3654 Could Change the Definition of Chiropractor in Medicare’s Eyes
Robert C. Jones, ACA (American Chiropractic Association) President writes in his article Support H.R. 3654 and Medicare Parity for Chiropractors and Their Patients, “for doctors of chiropractic, the bill would fully recognize DCs as ‘physicians’ in the Medicare program, acknowledging their level of education as well as the level of care they provide, and also bringing coverage of their services in line with how other physicians in the Medicare program are treated. At this time, DCs are the only physician-level providers whose services are arbitrarily restricted by statute.”
How H.R.3654 (Chiropractic Medicare Coverage Modernization Act of 2019) Can Change Medicare Chiropractic Coverage
H.R. 3654 is bipartisan legislation introduced by Congressman Brian Higgins (D-N.Y.) and Tom Reed (R-N.Y.) on July 9, 2019. In reading the bill the purpose is stated as “this Act to expand recognition and coverage of a doctor of chiropractic as a ‘physician’ under the Medicare program in connection with the performance of any function or action, including current service of ‘manual manipulation of the spine to correct a subluxation,’ as is legally authorized by the State in which such doctor performs such function or action.”
The bill would eliminate a portion of Section 1861(r)(5) of the Social Security Act (42 U.S.C. 1395x(r)(5)) that states: “a chiropractor who is licensed as such by the State (or in a State which does not license chiropractors as such, is legally authorized to perform the services of a chiropractor in the jurisdiction in which he performs such services), and who meets uniform minimum standards promulgated by the Secretary, but only for the purpose of sections 1861(s)(1) and 1861(s)(2)(A) and only with respect to treatment by means of manual manipulation of the spine (to correct a subluxation) which he is legally authorized to perform by the State or jurisdiction in which such treatment is provided.”
It would be replaced with:
“a doctor of chiropractic who is licensed as a doctor of chiropractic or a chiropractor by the State in which the function or action is performed and whose license provides legal authorization to perform such function or action in such State or in the jurisdiction in which the function or action is performed.”
Notice the change in wording from “chiropractor” to “doctor of chiropractor.” This is consistent with the purpose of the bill to recognize a doctor of chiropractor as a “physician” in the eyes of Medicare. Eliminated are the words “only with respect to treatment by means of manual manipulation of the spine.” This can be interpreted as additional coverage under Medicare as ordered and performed by chiropractors.
Will Chiropractors Be Able To Order Own Services?
Does that mean if H.R. 3654 is passed, chiropractors will be able to order, perform and bill Medicare for these tasks as do regular doctors and providers do now? Let’s look at the purpose of the bill again. “it is the purpose of this Act to expand recognition and coverage of a doctor of chiropractic as a ‘physician’ under the Medicare program in connection with the performance of any function or action, including current service of ‘manual manipulation of the spine to correct a subluxation’, as is legally authorized by the State in which such doctor performs such function or action.” This bill would label a chiropractor as a “physician” now and the words “the Medicare program in connection with the performance of any function or action,” certainly suggest under the new law if the bill is passed a chiropractor would be able to order, perform, and bill for their own procedures. We will have to see if the bill is passed and what actually transpires when the law goes into effect. If passing the bill does indeed allow chiropractors more latitude to order, perform, and bill for their own services much as regular physicians do it would in all likelihood lead to expansion of services by chiropractors.
As of now, Medicare has very little coverage for Chiropractic services. If H.R. 3654 passes, it looks as if that would not change much. However, with the passage of the bill and adding “physician” status to doctors of chiropractic, perhaps it would make it easier to allow chiropractors to order more tests and services to provide better healthcare services, at least in theory, for Medicare beneficiaries. Although there are many who do not believe chiropractic services are of any medical benefit and any funding for Medicare for Chiropractic services is wasteful. Whatever you think is your opinion. We hope the information from this article was useful for you.
Useful Resources Links:
Congress Website H.R. 3654 Chiropractic Medicare Coverage Modernization Act of 2019: http://bit.ly/HR3654_Bill
Current Medicare Chiropractic Law: http://bit.ly/Medicare_Chiro_Law
Joe Ragusa Article: http://bit.ly/JoeRagusa
CMS Chiropractic Billing and Guidelines: http://bit.ly/CMS_Billing_and_Coding
Robert C Jones ACA Article: http://bit.ly/ACA_President_Blog