chiropractic services

LOCATION OF SUBLUXATION

The mere statement or diagnosis of “pain” is not sufficient to support medical necessity for the treatments. The precise level of the subluxation must be documented by the chiropractor in the medical records.



Area of Spine     Names of Vertebrae     Number of Vertebrae    Short Form or Other Name    

Neck               Occiput Cervical Atlas Axis     7                           Occ, CO C1 through C7 C1 C2    
Back     Dorsal or Thoracic Costovertebral Costotransverse    12     D1 through D12
                                                                                                       T1 through T12
                                                                                                        R1  through R12
                                                                                                       R1 through R12    
Low Back     Lumbar                                       5                               L1 through L5    
Sacral          Sacrum, Coccyx                                                                  S, SC    
Pelvic          Ilia, R and L                                                                       I, Si    

In addition to the vertebrae and pelvic bones listed, the ilii (R and L) are included with the sacrum as an area where a condition may occur that would be appropriate for CMT.

There are two ways the level of the subluxation may be specified:
* The exact bones may be listed, for example, C5, C6, etc.
Or,
* The area may suffice if it implies only certain bones such as:
* Occipito-atlantal (occiput and C1 (atlas)).
* Lumbosacral (L5 and sacrum).
* Sacroiliac (sacrum and ilium).

There are three categories of conditions:

* Acute – A patient’s condition is considered to be acute when the patient is being treated for a new illness or injury. The result of chiropractic treatment is expected to be an improvement in, arrest or retardation of the patient’s condition.

* Chronic – A patient’s condition is considered chronic when it is not expected to completely significantly improve or be resolved with further treatment (as is the case with an acute condition), but where continued therapy can be expected to result in some functional improvement. Once the clinical status has remained stable for a given condition without expectation of additional functional improvement, further manipulation treatment is considered maintenance therapy and is not covered.

* Maintenance Therapy – A treatment plan that seeks to prevent disease, promote health, and prolong and enhance the quality of life, or maintain or prevent deterioration of a chronic condition is not a Medicare benefit. Once the maximum clinical benefit has been achieved for a given condition, ongoing maintenance therapy is not considered to be medically reasonable or necessary and is not payable under the Medicare program. An Advance Beneficiary Notice of Noncoverage (ABN) is required.

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