Please Note: There is no Medicare information on our corporate website. Please select a specific contract in the 'Search Within' box for Medicare related information.
© 2019 Palmetto GBA, LLC
We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.
Printed Date: 9/22/2015
As a Medicare provider, you may receive a request from the CERT Documentation Contractor (CDC), AdvanceMed, for medical records. There are special requirements for chiropractors when responding to requests from the CDC.
Chiropractic Medical Records and Documentation
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."
When the CDC requests documentation from Doctors of Chiropractic Medicine, the request letter will contain specific instructions to provide records/documentation for the preceding six months prior to the date of service for the sampled claim(s), if the services in those six months are associated with the same condition(s). When you submit documentation to the CDC in response to their request, it is imperative that you include the treatment plan to support chiropractic services planned and rendered for the course of treatment.
The treatment plan must contain the following elements:
The following documentation requirements apply whether the subluxation is demonstrated by X-ray or by physical examination and must be documented in the patient's record:
1. The history recorded in the patient record should include the following:
The precise level of the subluxation must be specifically identified by the chiropractor and documented in the medical record to substantiate a claim for manual manipulation of the spine.
To demonstrate a subluxation based on physical examination, two of the four criteria mentioned under "physical examination" are required, one of which must be asymmetry/misalignment or range of motion abnormality.
4. Diagnosis: The primary diagnosis must be subluxation, including the precise level of subluxation, either so stated or identified by a term descriptive of subluxation. Such terms may refer either to the condition of the spinal joint involved or to the direction of position assumed by the particular bone named.
5. Treatment Plan: The treatment plan should include the following:
We value your opinion and want to provide the highest-quality and most relevant Medicare knowledge possible. Please let us know if this article was helpful.
It didn't answer my question
This article was helpful
We’re glad we could help you today and appreciate your feedback. When you rate our articles as most helpful, we know that we are on the right track for providing you with important news and information.
We're sorry this article didn't help you today. We'll use your feedback to review this article to try to revise or expand it. Contact us with more feedback or a question on this topic.
Last Updated: 01/15/2019