Medicare is the federally sponsored fee-for-service health insurance program for people 65 years of age or older and certain younger people with disabilities. Medicare beneficiaries may choose the services of any care provider whose services are recognized by Medicare. Traditional Medicare has two Parts: Medicare Part A (hospital insurance) and Medicare Part B (general medical insurance).
Since their 1972 inclusion in the Medicare program, doctors of chiropractic have been recognized as physicians, but only for treatment by means of manual manipulation of the spine to correct a subluxation (i.e. spinal manipulation). Under the policies developed by the Centers for Medicare and Medicaid Services (CMS), Medicare Part B coverage of chiropractic services is specifically limited to medically necessary spinal manipulation services that are considered active/corrective in nature. The manipulative services rendered must have a direct therapeutic relationship to the patient’s condition and provide reasonable expectation of recovery or improvement of function. However, when further improvement cannot reasonably be expected from continuing care, the services are considered maintenance therapy, which is not considered medically reasonable or necessary under the Medicare program, and are therefore not covered/reimbursable. Additionally, although many Medicare procedures are within their scope of practice, no other diagnostic or therapeutic service furnished by a doctor of chiropractic, or under his or her order, is considered a covered service.
The Current Procedural Terminology (CPT) codes used when reporting chiropractic manipulation services include:
98940: Chiropractic Manipulative Treatment (CMT); spinal, one or two regions;
98941: CMT; spinal, three to four regions; and
98942: CMT; spinal, five regions.
If you are unable to find the necessary information in the resources listed below, please fill out the form located here. ACA would also encourage you to contact your Chiropractic Carrier Advisory Committee (CCAC) member for assistance specific to your state/carrier.