Late last year, CMS updated and issued a pair of educational resources that address Medicare coverage of chiropractic services.

The Medicare Learning Network booklet on chiropractic services (pdf) outlines the standards chiropractors must meet to render payable services under the program; common care provision scenarios (including exceptions) and actions that Medicare would take as a result; payment requirements; and frequently asked questions.

The Medicare Learning Network misinformation on chiropractic services fact sheet (pdf) seeks to clarify eight pieces of misinformation. They are as follows:

  1. There is a 12 visit cap or limit for chiropractic services.
  2. If you are a non-participating (non-par) provider, you do not have to worry about billing Medicare.
  3. If you are a non-par provider, you will never be audited nor have claims reviewed, etc.
  4. You can opt out of Medicare.
  5. You should get an advance beneficiary notification signed once for each patient and it will apply to all services, all visits.
  6. Maintenance care is not a covered service under Medicare.
  7. Non-par providers do not have the same documentation requirements as par providers.
  8. Durable medical equipment ordered by a DC will be reimbursed by CMS.

The rules for chiropractor billing are quite complex, which is why many providers choose to outsource their chiropractor billing services to a company like PGM Billing, one of the nation’s leading chiropractic billing vendors. PGM has more than 30 years of billing experience, and a team of certified, expert billers dedicated to billing for chiropractic services.