Medicare Coverage for Chiropractic Treatment
What is Chiropractic Therapy?
Chiropractic medicine is the treatment of the function of the spine and pelvic region and how it relates to the spinal cord and nervous system and related structures.
In the eyes of Medicare chiropractors treat “subluxations” of the spine or areas that are slightly out of place placing pressure on joints altering the function of the spine and nervous system.
The most common conditions that are treated under Medicare are the following:
- Back pain
- Neck pain
- Low back pain
- Pain in the upper arms or legs due to subluxations creating neuralgia
Chiropractic care is a “natural” approach to health. There are no medications prescribed, therefore we are a drug free practitioner with a “hands on” approach, hence the name “Chiro” meaning hand and “Practic” meaning practical, together meaning “Practical hands”. The procedure that is performed is “spinal manipulation” or “chiropractic adjustment”. This can be accomplished by many techniques employed by the doctor. The goal of treatment is to restore motion, alleviate pain and reduce or eliminate muscle tightness in order to allow tissue to increase blood supply and oxygen to heal.
Medicare necessitates an exam be performed. However, it does not cover the examination. The exam is important to help make a determination if chiropractic is appropriate. If x-rays are needed you will be referred out to a facility, which will not be covered by Medicare.
What is covered by Medicare?
Medicare Part B: Part “B” pays for a chiropractor’s manual manipulation of the spine to correct a subluxation.
What is not covered by Medicare:
Medicare does not cover the following services performed by a chiropractor:
- Initial physical examinations
- Evaluation services
- Physical therapy
- Vitamin, mineral and/or food supplements, or other supplies
- Orthopedic devices
Do I Qualify for Chiropractic Services?
Your chiropractic treatment is covered by Medicare part “B” ONLY if:
- You have a neuromusculoskeletal condition that needs treatment
- You have a subluxation of the spine
- Manual manipulation has been recommended for improvement of your condition
What Do I Pay?
There is a yearly calendar deductible amount that you will have to pay of $ 150. Your insurance copayment is based upon the Medicare approved amount.
Medicare reimbursement will be limited to one visit per day, unless there is a medical need for more than one treatment each day.
The hands-on nature of the chiropractic treatment requires patients to visit the chiropractor a number of times. To be treated by a chiropractor, a patient needs to go into the office. A chiropractor may provide acute, chronic, and/or preventive care thus making a certain number of visits sometimes necessary. Your doctor of chiropractic should tell you the extent of treatment recommended and how long you can expect it to last.
Each visit must be medically necessary and enhance or improve musculo-skeletal your condition. Once further improvement cannot reasonably be expected from continuous ongoing care, the treatment is considered supportive/preventive, and Medicare will stop paying for treatment.
Does Dr. Sabato accept assignment from Medicare:
Dr. Sabato does accept assignment from Medicare. There are other health care plans that are substituted for Medicare, which Dr. Sabato may not be a preferred provider for.
You will have to do your homework and call your plan to see if Dr. Sabato is a provider.
What about Secondary Insurance Coverage to Medicare:
Medicare usually automatically sends billing over to the secondary insurance carrier.
In Case of an Accident:
Medicare will not cover for an accident. The other insurance will have to be billed and it becomes the primary insurance.
What If I have a HMO?
If you belong to an HMO or Health Maintenance Organization you must usually have authorization and a referral in writing from your primary care physician (PTP) prior to starting care in order to have Medicare to cover your chiropractic care. Each plan is different and we must follow their rules.
Medicare laws and state regulations are subject to change from time to time and that the above policy may not cover those changes but may be changed to conform to such laws and regulations. Medicare may deny payment for treatment at anytime.
Medicare may consider more than eighteen (18) spinal manipulations during the year to be “medically not reasonable and necessary”. You may be held responsible for any visits that were not covered by Medicare.