# Chiroprator orders for MRI/CT



## vballew (Feb 22, 2012)

We have read that Chiropractor's cannot order MRI/CT for Medicare/Medicaid.  With that being said can the radiologist order an MRI/CT for the chiropractor if need be?  Do you have to get the order from the patient's treating physician?  I have googled and looked everywhere I can to find more specific info and am not having any luck.  Please help.


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## donnajrichmond (Feb 22, 2012)

vballew said:


> We have read that Chiropractor's cannot order MRI/CT for Medicare/Medicaid.  With that being said can the radiologist order an MRI/CT for the chiropractor if need be?  Do you have to get the order from the patient's treating physician?  I have googled and looked everywhere I can to find more specific info and am not having any luck.  Please help.



Not any more.  Diagnostic tests for the chiropractor are not payable. 
Here's some info from ACR Coding Source, May/June 2010: 
Question:  Have the Centers for Medicare and Medicaid Services (CMS) changed their guidelines on the chiropractor exemption for plain film x-rays that allows radiologists to order diagnostic tests?

Yes, as noted in the January/February 2008 ACR Radiology Coding Source, CMS no longer has a “chiropractor exception” that allows nontreating physicians, such as radiologists, to order diagnostic tests at a chiropractor's request to identify a subluxation of the spine.

Prior to January 1, 2000, the law required that an x-ray confirm the subluxation diagnosis for Medicare to reimburse for chiropractic adjustments to correct subluxations. Radiologists, however, did not qualify under Medicare rules as a treating physician, and chiropractors are not permitted to order x-rays. Therefore, the regulations provided a “chiropractor” exception.  In 2000, the law eliminated the requirement for x-ray confirmation of spinal subluxations; however, the chiropractor exception remained in Medicare rules for eight years. In 2008, CMS acted to align its reimbursement policies with the 2000 statutory change. Consequently, CMS no longer pays for x-rays or other diagnostic tests ordered by a nontreating physician to be used by chiropractors to demonstrate subluxation.

The following language is stated in the Medicare Benefit Policy Manual, Chapter 15 §240.1

“Coverage of chiropractic service is specifically limited to treatment by means of manual manipulation, i.e., by use of the hands. No other diagnostic or therapeutic service furnished by a chiropractor or under the chiropractor's 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.”


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## vballew (Feb 23, 2012)

Thanks for your help.


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