chiropractic X- RAY coverage

Medicare X RAY coverage

As of January 1, 2000, an x-ray is not required by Medicare to demonstrate the subluxation. However, an x-ray may be used for this purpose if you so choose. The x-ray must have been taken reasonably close to (within 12 months prior or 3 months following) the beginning of treatment. In certain cases of chronic subluxation (e.g., scoliosis), an older x-ray may be accepted if the beneficiary’s health record indicates the condition has existed longer than 12 months and there is a reasonable basis for concluding that the condition is permanent. A previous CT scan and/or MRI are acceptable evidence if a subluxation of the spine is demonstrated.

X-RAYS ORDERED/REFERRED BY A CHIROPRACTOR

Coverage of chiropractic services is specifically limited to treatment by means of manual manipulation. No other diagnostic or therapeutic service furnished by a chiropractor or under his order is covered. The X-ray may be used for documentation, but Medicare will make no payment to the Doctor of Medicine (MD) or Doctor of Osteopathy (DO) if the chiropractor orders the X-ray.

This clarifies the current policy regarding payment of diagnostic X-rays either ordered by or referred by a chiropractor. If a chiropractor directs or refers the patient to the radiologist to obtain an X-ray to demonstrate a subluxation prior to beginning treatment, and the radiologist performs the X-ray based upon the chiropractor’s evaluation of the patient, the radiologist should report the chiropractor as the ordering provider on the claim form. Medicare will deny the service as non-covered, the beneficiary will be responsible for payment, the ABN will not apply, and advance written notice will not be required.

If the patient is referred by the chiropractor to the radiologist, and the radiologist then determines that an X-ray is appropriate, the radiologist assumes responsibility for ordering the X-ray and enters his name and ID number as the ordering physician on the claim form; Medicare will not deny the claim. The radiologist is not precluded from ordering a diagnostic X-ray. However, in this case, we would expect the radiologist to maintain adequate documentation to substantiate the medical necessity of the services he has ordered based upon his evaluation of the patient. In the event of a postpayment review of claims, we would request this documentation to validate payments made to the radiologist. In addition, no other diagnostic or therapeutic service performed by a chiropractor or ordered by a chiropractor is covered (e.g., physical therapy).