Medicare FAQ

Legislation championed by ACA to expand Medicare coverage of services has been introduced in the U.S. House of Representatives.

The bill, H.R. 7157, introduced on Nov. 16, would allow Medicare beneficiaries to access the chiropractic profession’s broad-based, non-drug approach to pain management, which includes manual manipulation of the spine and extremities, joint mobilization, soft-tissue massage techniques, physiological therapies, exercise instruction and activity advice. The bill adds no new services; it only allows access to those current Medicare benefits that chiropractors are licensed to provide.

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. 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 115th Congress is winding to a close, and at least 90 new members have been elected to the House or the Senate. It is unlikely Congress will have a chance to act on H.R. 7157, so we are focused on laying the ground work for 2019. When the 116th Congress convenes in January, nearly 20 percent of Congress will be new to their position. This represents a significant amount of outreach and education that we will need to undertake.

Even so, the bill’s introduction is an important milestone. Our ideas have been drafted into legislative language that will be more familiar to all involved, and a bill number in the House of Representatives paves the way for reintroduction next year.

If that’s the case, what can I do NOW?

ACA is your voice on Capitol Hill:

Join Us

Ask your patients, family and friends to sign the petition:

Sign the Petition

We encourage ACA members, SACA students and anyone else with an interest in further integrating access to chiropractic services in Medicare, to urge patients, friends and family to sign the petition calling on Congress to change the current Medicare statute.  Point your patients, friends and family to https://www.acatoday.org/equality/doctors where they can become part of the campaign to provide full patient access to services provided by doctors of chiropractic in Medicare.

Urge your state association leaders to sign the open letter to Congress expressing support for changing the antiquated statute that chiropractic patients currently face. This will show Congress that there is solidarity within the profession to ensure that patients have access to the essential services that doctors of chiropractic provide.

Also, make plans to come to the National Chiropractic Leadership Conference (NCLC) in January in Washington DC.   Contact your ACA state delegate to let them know you want to come and be part of the solution!  Register for NCLC.

Which codes are covered by the proposed bill?

It’s not known exactly which codes would be covered. At a minimum, if passed in its current form, the legislation would include selected evaluation and management (E&M) codes, post therapy, and certain x-ray codes, if applicable. 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.

Is the option to opt out of Medicare included in the new bill?

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 to the full scope of their state license, and makes it possible to work toward other improvements. Opt-out options may require further legislation.

In Section 3 of the bill, what does the provision regarding “Certain Coverage Limits” mean for me?

This provision was added at the request of legislative drafters to support the provision that was included in the 2015 Medicare Access and CHIP Reauthorization Act, better known as MACRA. As you recall, included in MACRA was a requirement (Sec. 514 of Public Law 114-10) that CMS develop a process for medical review, and potentially place on prior authorization, chiropractors who have aberrant billing patterns. 

What this bill means is that chiropractors will be able to bill Medicare for the full scope of their services allowed by their state, provided they have not been identified as having billing patterns much different than their peers. This would be a significant expansion to ensure we can continue to care to our patients as they age.

However, the inclusion of this provision shows the seriousness of Congress to take on what it feels are inappropriate payments. In order to fully allow chiropractors unfettered access to Medicare billing, the profession will need to continue to address this issue head on and the ACA stands ready to help all Chiropractors to meet that charge.

Check out Learn ACA's Medicare Training for the Chiropractic Office to improve your documentation in Medicare and earn CE.

Medicare Training for the Chiropractic Office