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Chiropractic Services

Medicare coverage of chiropractic service is specifically limited to treatment by means of manual manipulation of the spine to correct a subluxation (that is, by use of the hands). The patient must require treatment by means of manual manipulation of the spine to correct a subluxation and the manipulative services rendered must have a direct therapeutic relationship to the patient's condition and provide reasonable expectation of recovery or improvement of function. Additionally, manual devices (that is, 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. However, no extra payment is available for use of the device, nor does Medicare recognize an additional charge for the device itself.

Claim Submission Requirements - Claim Submission highlights on covered and noncovered services performed by a Chiropractor

Documentation Guidelines - CMS has developed policies which specifically limit coverage to manual manipulation of the spine to correct a subluxation. The codes that accurately reflect this service are the CPT codes 98940, 98941, and 98942. Documentation must clearly reflect the medical necessity for the service billed

Excluded Chiropractic Services - View services excluded from Medicare benefits

General Coverage and Subluxation - General Chiropractic coverage/coverage categories and subluxation information

Excluded Chiropractic Services

A Beneficiary is responsibility for these services. A provider may bill patient without billing Medicare.

  • Acupuncture
  • Counseling/education
  • Dietary advice/nutritional supplements
  • Lab or other diagnostic tests
  • Physical therapies (exercise, ultrasound, traction)
  • Office visits
  • Supplies (pillows or vitamins)
  • Supportive (bracing, orthopedic)
  • X-rays

Resources

Last Updated Jun 19, 2017

Related Articles

The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.