Health Information Management

Q/A: May chiropractors order services for Medicare patients?

APCs Insider, September 2, 2011

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Q: We recently learned that CMS now allows chiropractors to order services and refer Medicare beneficiaries. We have not been accepting orders for services from chiropractors. Instead, we have required our patients to see their regular physicians for assessment and orders for necessary tests. When did this change occur? How can we explain this to beneficiaries and their physicians who have become accustomed to what are now unnecessary steps?

A: CMS erred when it published information that indicated chiropractors could provide orders for beneficiaries. CMS recently published this notice through the provider resource listserv:

Chiropractors Not Eligible to Order and Refer

In recent announcements and materials, CMS incorrectly included chiropractors in the list of physician and practitioner types that may order and refer items or services to Medicare beneficiaries. In accordance with section 1877(a)(1) and (5)(A), and section 1861(r)(5) of the Social Security Act, and 42 CFR 410.21(b)(1) and (2), doctors of chiropractic medicine are not eligible to order and refer. Medicare coverage extends only to treatment by means of manual manipulation of the spine to correct a subluxation; all other services furnished or ordered by chiropractors are not covered.

So you are on the correct path with your order acceptance process.

Editor’s note: Denise Williams, RN, CPC-H, director of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.

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