Billing Of DMEPOS With Chiropractors As Referring Physician

Original Effective Date: 06/14/2002
Revision Effective Date: 11/01/2013

Suppliers are reminded of a longstanding Medicare regulation that items and services ordered by chiropractors are statutorily excluded from Medicare coverage. The Medicare Carriers Manual §2251 states that Medicare coverage of chiropractic services is specifically limited to treatment by means of manual manipulation. No other diagnostic or therapeutic service furnished by a chiropractor or under his or her order is covered.

Based on data analysis, Region D has identified numerous claims with a referring chiropractor UPIN (Unique Physician Identifier Number). In accordance with the findings of this widespread billing problem, Region D will edit for claims for DMEPOS items with chiropractors listed as the referring UPIN received on or after September 1, 2002, and deny them as statutorily noncovered (Social Security Act §1861(r)(5)). Previously paid claims for DMEPOS items ordered by chiropractors may be selected for postpayment review and denied similarly. Suppliers are urged to voluntarily refund Medicare for payment received for items ordered by chiropractors (see DMERC Region D Supplier Manual, Chapter 12, and the article on page 15 of this DMERC Dialogue for voluntary refund instructions.)

Last Updated May 05 , 2017