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Chiropractic Services: Submission of Claims for Services Excluded from Medicare Coverage
Medicare coverage of services performed by chiropractors is limited to treatment by means of manual manipulation of the spine to correct a subluxation, provided such treatment is legal in the state where performed. All other services furnished or ordered by chiropractors are not covered.
If a chiropractor orders, takes or interprets an X-ray or other diagnostic procedure to demonstrate a subluxation of the spine, the X-ray can be used for documentation. However, there is no coverage or payment for these services or for any other diagnostic or therapeutic service ordered or furnished by the chiropractor.
In addition, in performing manual manipulation of the spine, some chiropractors use manual devices that are hand-held with the thrust of the force of the device being controlled manually. While such manual manipulation may be covered, there is no separate payment permitted for use of this device.
Services such as office visits (evaluation and management services), diagnostic studies, physical therapy and other services rendered by chiropractic are not required to be submitted for coverage consideration by the Medicare program. The Centers for Medicare & Medicaid Services (CMS) does not require providers to submit claims for services that are excluded by statute under Section 1862(a)(1)(A) of the Social Security Act. If a Medicare beneficiary believes a service may be covered or requests a formal Medicare determination for consideration by a supplemental plan, the provider must submit a claim.
- To submit a claim for a non-covered service by a chiropractor, use HCPCS modifier GY to indicate that the service is statutorily excluded from coverage
- You may submit both covered and non-covered services on the same claim
Note: Therapy services provided by a chiropractor, although non-covered, must be submitted according to therapy guidelines. Therefore, please be sure to include one of the therapy modifiers defined below. Therapy services submitted without the appropriate modifier will be rejected as unprocessable.
- HCPCS modifier GN — Services delivered under an outpatient speech-language pathology plan of care
- HCPCS modifier GO — Services delivered under an outpatient occupational therapy plan of care
- HCPCS modifier GP — Services delivered under an outpatient physical therapy plan of care
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."