Chiropractic Coding & Compliance Alert

Question: The chiropractic provider ordered an X-ray and provided manipulation of the lumbar spine to correct a subluxation. He also provided massage to the area surrounding the thoracic spine. The patient has Medicare coverage. How would the reimbursement for this case proceed?

Texas Subscriber

Answer: If the provider has provided adequate documentation in the P.A.R.T. format and proved the presence of a subluxation, thereby confirming the medical necessity for the spinal manipulation, Medicare Part B will pay for the spinal manipulation when provided by a chiropractor or other qualified provider. This coverage is for all people under Medicare.

Cost to patient: The patient pays 20 percent of the Medicare approved amount and the Part B deductibles as applicable. He has to pay all costs for other services or tests ordered by a chiropractor (including X-rays and massage therapy).

Note: The patient’s cost may depend on several things, like other insurance that he may have, how much the provider charges, the type of facility, and the location of service.