Medicare defines the following requirements for coverage and payment of chiropractic manual manipulation of the spine:
- A neuromusculoskeletal condition that requires treatment
- Manipulative services that are directly related to the patient's condition
- There is an expectation of recovery or improvement
- The patient must have a subluxation of the spine demonstrated by X-ray or physical exam
Upon determination of a subluxation, the physician is required to develop an individualized treatment plan that includes the following:
- Recommended level of care (duration and frequency of visits)
- Specific treatment goals
- Objective measures to evaluate treatment effectiveness
CMS does not require that the treatment plan be updated on each visit. However, subsequent visits during the treatment period require the following documentation in the patient's medical record:
- History
- Review of chief complaint
- Changes since last visit
- System review, if relevant
- Physical Exam
- Exam of area of the spine involved in diagnosis
- Assessment of change in the patient's condition since the last visit
- Evaluation of treatment effectiveness
- Treatment
- Documentation of treatment given on the day of the visit
Signature Requirements:
Medicare requires the individual who ordered/provided services be clearly identified in the medical records. The signature for each entry must be legible and should include the practitioner’s first and last name and applicable credentials, e.g., P.A., D.O., or M.D. For more information about signatures, please refer to the article titled “Medicare Part B Medical Records: Signature Requirements, Acceptable and Unacceptable Practices.”
Chiropractic Resources:
The Centers for Medicare & Medicaid Services (CMS)
- "Chiropractor by Definition": Publication 100-01, Medicare General Information, Eligibility & Entitlement, Chapter 5, section: 70.6; www.cms.hhs.gov/manuals/downloads/ge101c05.pdf (PDF, 232 KB)
- "Chiropractic Coverage": Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, section 30.5:
www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf (PDF, 1.10 MB)
- "Chiropractic Medical Necessity": Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, section 240: www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf (PDF, 1.10 MB)
- "Chiropractic Documentation Requirements": Publication 100-04, Medicare Claims Processing Manual, Chapter 12, section 220: www.cms.hhs.gov/manuals/downloads/clm104c12.pdf (PDF, 920 KB)
Palmetto GBA Resources: