The Chiropractic Medicare Coverage Modernization Act (H.R. 1610 / S. 799) will allow Medicare beneficiaries access to the chiropractic profession’s broad-based, non-drug approach to pain management, which includes manual manipulation of the spine and extremities, evaluation and management services, diagnostic imaging and utilization of other non-drug approaches that have become an important strategy in national efforts to stem the epidemic of prescription opioid overuse and abuse.
The Chiropractic Medicare Coverage Modernization Act:
Is bipartisan legislation that provides patient access to all Medicare-covered benefits allowable under a chiropractor’s state licensure.
Appropriately defines a Doctor of Chiropractic (DC) as a “physician” in the Medicare program.
What does this legislation mean for me and my Medicare patients?
Simply put, the bill, and ACA’s entire Medicare initiative, is to ensure patient access to all Medicare-covered services that DCs are licensed to provide. Again, it is important to note that our initiative adds no new services. It only allows access to those current Medicare benefits that chiropractors are licensed to provide. The current statute that governs patient access to Medicare has been in place since 1972. It’s antiquated and does not reflect the acceptance of chiropractic into mainstream health care. In addition, it limits patient choice, which is a highlight of our educational efforts with legislators.
What happens next?
The bill needs your support! Members of Congress want to hear from YOU, the constituent, more than anyone else. We are asking that every DC contact their Members of Congress and urge them to cosponsor H.R. 1610. It is critical that Members of Congress hear a pro-chiropractic message directly from constituents, the people they represent!
Resources, toolkits and templates are available for you to use in your communication with policymakers and the general public. We are here to support you and the Government Relations team is available to help or answer any questions you may have.
Help your legislators understand the importance of increased patient access to chiropractic.
Which codes are covered by the proposed bill?
If and when bills become laws, the federal rulemaking process determines implementation. Details related to codes, reimbursement and billing will not take place until then. Be advised, that under H.R. 1610, DCs would be paid under the Medicare physician fee schedule for all services listed thereon which are authorized under their state scope of practice in the same manner MDs are paid. Also, be aware that the Medicare physician fee schedule is based on the relative value of the various services and not on the type of physician providing the service. At a minimum, if passed in its current form, the legislation would include evaluation and management (E&M) codes, therapy codes including but not limited to CMT codes, and certain diagnostic and x-ray codes.
A question I keep getting from members of congress and their staff is: “So, what does it cost?”
The bill does not add new services to Medicare, it simply allows for patient choice when selecting a provider. H.R. 1610 allows patients to choose a chiropractor for Medicare-covered services allowed by their state.
Is the option to opt out of Medicare included in the new bill?
This bill is intended to give patients greater access to chiropractic services in Medicare. The first step is to put chiropractors on par with all other physicians within the Medicare system. This lays the foundation for patients to receive covered services from their chiropractors that are allowed under their state licensure, and makes it possible to work toward other improvements. Opt-out options will require further legislation after full access is achieved.
The bill mentions completing an ‘educational documentation webinar.’ What does that mean?
This bill means that chiropractors will be able to bill Medicare for the full scope of their services allowed by their state, provided they have completed documentation training in the form of a one-time webinar or similar process, as determined by the Centers for Medicare and Medicaid Services (CMS).
What happened to H.R. 2654 and S. 4042?
H.R. 2654 and S. 4042 were introduced in the 117h Congress and created strong momentum for the modernization of chiropractic coverage in Medicare. Through the hard work of ACA members and DCs nationwide, the bill attracted more than 150 cosponsors.
The bills expired at the end of the 117th Congress in December 2022, requiring ACA to push for reintroduction of the Chiropractic Medicare Modernization Act in 2023. The push to acquire more cosponsors begins anew with H.R. 1610 / S. 799. The text of the bills remains the same in the 118th Congress, and bipartisan, bicameral support will continue to propel this legislation forward.
Background: Medicare Coverage for Chiropractic Patients
To best serve their senior patients, chiropractic physicians must be allowed to practice and be reimbursed to the fullest extent of their licensure, training and competencies. Medicare access for patients of chiropractic is ACA’s top legislative and regulatory priority.
Since the chiropractic profession was first included in Medicare in 1972, Doctors of Chiropractic (DC) and their patients have been burdened by arbitrary limitations that lack any scientific or sound policy justification.
Research demonstrating positive patient outcomes and cost effectiveness resulting from chiropractic care have advanced private coverage and state licensures to meet patient needs.
The federal Medicare program, which serves as a model for private insurance plans, currently serves more than 55 million individuals. Various projections forecast the number of people age 65 or older increasing by about one-third over the next decade. Chiropractic inclusion in the Medicare program was established in 1972 and has seen little change since then, other than elimination of the X-ray requirement in 1997.
Chiropractic in Medicare Timeline (PDF)
The American Chiropractic Association (ACA) is the largest professional chiropractic organization in the United States. ACA attracts the most principled and accomplished chiropractors, who understand that it takes more to be called an ACA chiropractor.