Article - Billing and Coding: Chiropractic Services (A56616)

CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.42 CFR 410.21 describes limitations on services of a chiropractor.CMS Internet-Only Manual, Pub. 100-01, Medicare General Information, Eligibility and Entitlement Manual, Chapter 5, 70.6 Chiropractors.CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, 30.5 Physician Services-Chiropractors Services.Article TextThe information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Chiropractic Services L37387.Limitations:Coverage of chiropractic service is specifically limited to treatment by means of manual manipulation, i.e., by use of the hands. Additionally, manual devices (i.e., 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 additional payment is available for use of the device nor does Medicare recognize an extra charge for the device itself.No other diagnostic or therapeutic service furnished by a chiropractor or under the chiropractors order is covered. This means that if a chiropractor orders, takes or interprets an x-ray or any other diagnostic test, the x-ray or other diagnostic test can be used for claims processing purposes but Medicare coverage and payment are not available for those services. This prohibition does not affect the coverage of x-rays or other diagnostic tests furnished by other practitioners under the program. For example, an x-ray or any diagnostic test taken for the purpose of determining or demonstrating the existence of a subluxation of the spine is a diagnostic x-ray test covered under 1861(s)(3) of the Social Security Act if ordered, taken and interpreted by a physician who is a doctor of medicine or osteopathy.The precise level(s) of the subluxation(s) must be specified by the chiropractor to substantiate a claim for manipulation of each spinal region(s).Medicare does not cover chiropractic treatments to extraspinal regions.For Medicare purposes, a chiropractormustplace an AT modifier on a claim when providing active/corrective treatment to treat acute or chronic subluxation. However, the presence of the AT modifier may not in all instances indicate that the service is reasonable and necessary. As always, contractors may deny if appropriate after medical review. Modifier AT must only be used when the chiropractic manipulation is reasonable and necessary as defined by national policy and the Chiropractic Services L37387 LCD. Modifier AT must not be used when maintenance therapy has been performed. The need for a prolonged course of treatment should be appropriate to the reported procedure code(s).The precise level of subluxation must be specified by the chiropractor to substantiate a claim for manipulation of the spine.A statement on a claim that there is pain is insufficient.Only 1 chiropractic manipulation service for a beneficiary can be reimbursed per day.