How Are Seniors Affected by Medicare's Limited Coverage of Chiropractic?

By Don Handley, DC

Chairman, ACA Senior Citizens Committee

San Antonio, Texas


There are a number of negative effects on our senior patients because Medicare only reimburses DCs the service of “manual manipulation of the spine to correct a subluxation.” For one, there is the negative effect on the individual patient’s wallet from having no Medicare payments for X-rays, examinations, therapies, extremity adjusting, clinical labs and a number of procedures taught in our chiropractic colleges or included within our state scope of practice. Generally, this also hampers the profession’s ability to truly represent all that chiropractic can do for seniors.  


The government has historically put obstacles in the way of Medicare beneficiaries’ ability to receive and be reimbursed for the chiropractic care that they want, need and deserve.  Until a few years ago, X-rays were required to diagnose a subluxation—but were not reimbursed. Now, X-rays are not required but we have to demonstrate subluxation through an examination to make an appropriate diagnosis—and, again, that exam is not reimbursed.


Patients are surprised to learn that chiropractic services are covered under Medicare.  However, they are not necessarily aware that standard services are not covered at the chiropractor's office—such as exams, therapies and x-rays—when these same services would be covered at the MD’s or DO’s office. They believe this is an injustice.    


On behalf of our patients, and the growing senior population in general, chiropractors have asked for expanded reimbursement for three decades.  We are now one year into a two-year chiropractic demonstration project. Doctors in the demonstration project have an opportunity to make history and gain expanded reimbursement for the entire profession. These doctors have an opportunity to bill and be reimbursed by Medicare for evaluation, therapy, lab and radiology services. For the first time, our Medicare patients in these areas have an opportunity to be reimbursed for more of our services under their Part B benefits. 


This opportunity will not come our way again. The doctors that participate in this history-making project are contributing to the greater wellness of the country’s population and doing their part to ensure that chiropractic will be an option for the baby boomers. Those of us outside the demo areas should thank our peers within Maine, New Mexico, the 26 counties in Illinois, the 17 counties in Virginia, and Scott County in Iowa.


We also have the opportunity outside the demo areas to help represent the profession on another level. With the ongoing demonstration on the use of Recovery Audit Contractors (RAC) effecting physicians in New York, California and Florida; and the June 2005 release of the HHS Office of Inspector General (OIG) report on chiropractic documentation errors and the resulting OIG Action Plan created by the profession; we are seeing more and more instances in which the powers that be are interested in the proper documentation of our services. As DCs, we have a responsibility to our patients to ensure that they will continue to have access to our services, and one of the best ways we can all do that right now is by educating ourselves about documentation. (Editor’s Note: In accordance with the plan set forth in the OIG Action Plan, the ACA’s Clinical Documentation Manual is being offered to the profession for a limited time at a steeply discounted price, $39.99. To reserve your copy, call (800) 368-3083.)


As Medicare goes, so goes the rest of the industry; we have seen this happen throughout the country. Our future in insurance and Medicare is up to us; the time is now. To expand our services in Medicare, we must take matters into our own hands. We have to document our patients’ cases so there is no question as to medical necessity, and we must fully participate in the Medicare demonstration project currently underway.