Will Medicare Change Their Rules Regarding Coverage of Services Provided by a Chiropractor?

August 13th, 2019 - Wyn Staheli, Director of Research
Categories:   CPT® Coding   Medicare   Chiropractic   Compliance  
0 Votes - Sign in to vote or comment.

Two separate pieces of legislation have been introduced in the House of Representatives which have the potential to change some of Medicare’s policies regarding doctors of chiropractic. Other payers allow chiropractors to do more than spinal manipulation and even state licensing boards have a great deal more listed as being included within their scope of practice. The two bills approach the problem from different angles, they are :

H.R. 2883 is supported by the International Chiropractor Association and proposes to revise the Social Security Act definition of a physician in section 1802(b)(6)(B) as follows:

(B) Physician.—The term “physician” has the meaning given such term by paragraphs (1), (2), (3), and (4) of section 1861(r).

Paragraph (5) of Section 1861(r) says doctors of chiropractic are defined as a physician but only for manual manipulation. It states the following (emphasis added):

(5) 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. . 

While this small change will allow doctors of chiropractic to have the ability to ‘opt out’ of Medicare like other physicians, it still doesn’t change the scope of allowed services.

H.R. 3654 goes a little further than H.R. 2883. The Act states:

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.

We believe that more closely aligning the Medicare program with state scope of practice is a good idea. Clinical Congress, formerly COCSA, issued a letter on July 29, 2019 in support of this legislation (see References below). They stated “While ChiroCongress supports legislative efforts which we believe positively impact the profession, we encourage each association to independently assess support of legislative efforts with your association’s leadership team.”

Summary

At the time of this article, it doesn’t appear that either bill is moving forward very quickly. H.R. 3654 has been referred to the Committee on Energy and Commerce, where many bills get held up. The only way that things will move forward is with continued support. Contact the association(s) you are affiliated with as well as your state congressional members. CLICK HERE to obtain your state representative information.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

A 2020 Radiology Coding Change You Need To Know
February 10th, 2020 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
The radiology section of the 2020 CPT© has 1 new, 18 revised, and 14 deleted codes. Interestingly, six of the 14 deleted codes were specific to reporting single-photon computerized tomographic (SPECT) imaging services of the brain, heart, liver, bladder, and others. If your organization reports radiology services, it is...
Documenting telephone calls at your dental practice is just as important as documenting patient visits.
February 4th, 2020 - Christine Taxin
Documenting telephone calls at your dental practice is just as important as documenting patient visits. Similar to other documentation, the common rule when it comes to call documentation is that if it is not documented, it did not happen. Therefore, every clinically relevant telephone call should be documented. Clinically relevant calls ...
CPT 10-Year Historical Content - Now Available!
January 22nd, 2020 - Find-A-Code
Did You Know? We now offer Historical CPT Content in 2-year, 5-year, or 10-year options! Utilize access to specific CPT historical data for previous years using rules effective at that specific time. If you’ve added UCR fees to your account, you can use Historical CPT Content to view UCR fees from ...
Inadequate Exclusion Screenings Could Put Your Practice at Risk
January 21st, 2020 - Wyn Staheli, Director of Research
Exclusion screenings require far more than just checking a name on a federal database at the time you are hiring someone. Far too many providers don’t realize that in order to meet compliance requirements, there is MUCH more involved. There are actually over 40 exclusion screening databases/lists that need to be checked.
Q/A: How do we Bill Massage Services?
January 21st, 2020 - Wyn Staheli, Director of Research
Question: We are adding a massage therapist soon and have some questions about billing their services.
Billing for Telemedicine in Chiropractic
January 14th, 2020 - Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP
Many large private payers recognize the potential cost savings and improved health outcomes that telemedicine can help achieve, therefore they are often willing to cover it. While there are several considerations, there could be certain circumstances where telemedicine might apply to chiropractic care.
Non-Surgical Periodontal Treatment
January 14th, 2020 - Christine Taxin
AAP treatment guidelines stress that periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment.Non-surgical periodontal treatment does have its limitations. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health.SCALING AND ROOT PLANINGScaling ...



About Codapedia by innoviHealth® Contact Us Terms of Use Privacy Policy Advertise with Us

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2020 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association