Medicare coverage limitation of chiropractic billing

INDICATIONS AND LIMITATIONS OF COVERAGE AND/OR MEDICAL NECESSITY

For the purpose of Medicare, subluxation means 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 usually falls into one of two categories:

* Acute, such as strains and sprains.

* Chronic, such as loss of joint mobility.

Note: No other diagnostic or therapeutic service furnished by a chiropractor or under his order is covered under the Medicare program.

Acceptable terminology for the Chiropractic Manipulative Treatment (CMT) being provided includes:

*Spinal adjustment by manual means.

* Spinal manipulation.

* Manual adjustment or manipulation.

* Vertebral manipulation or adjustment.

Manual devices (those devices that are hand-held with the thrust of the force of the device being controlled manually) may be used by a chiropractor in performing manual manipulation of the spine. However, no additional payment is allowed for the use of the device or for the device itself.

The five spinal regions referred to in this policy on CMT are:

* Cervical region.

* Thoracic region.

* Lumbar region.

* Sacral region.

* Pelvic.