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July 28, 2014

Chiropractic Services: Submission of Claims for Services Excluded from Medicare Coverage

Medicare coverage of services performed by chiropractors is limited to treatment by means of manual manipulation of the spine to correct a subluxation, provided such treatment is legal in the state where performed. All other services furnished or ordered by chiropractors are not covered, including but not limited to:

  • X-rays (spinal or other)
  • Evaluation & Management (E/M) services
  • Diagnostic studies
  • Physical and occupational therapy

Submitting Claims for Non-Covered Services

Services such as office visits (evaluation and management services), diagnostic studies, physical therapy and other services rendered by chiropractic are not required to be submitted for coverage consideration by the Medicare program. The Centers for Medicare & Medicaid Services (CMS) does not require providers to submit claims for services that are excluded by statute under Section 1862(a)(1)(A) of the Social Security Act. If a Medicare beneficiary believes a service may be covered or requests a formal Medicare determination for consideration by a supplemental plan, however, you must submit a claim.

  • To submit a claim for a non-covered service by a chiropractor, use HCPCS modifier GY to indicate that the service is statutorily excluded from coverage.
  • You may submit both covered and non-covered services on the same claim.

Therapy Services

Although therapy services provided by a chiropractor are not covered, if the beneficiary asks you to file a claim for these services, they must be submitted with one of the following therapy modifiers:

  • HCPCS modifier GN - Services delivered under an outpatient speech-language pathology plan of care
  • HCPCS modifier GO - Services delivered under an outpatient occupational therapy plan of care
  • HCPCS modifier GP - Services delivered under an outpatient physical therapy plan of care

X-rays

If a chiropractor orders, takes or interprets an X-ray or other diagnostic procedure to demonstrate a subluxation of the spine, the X-ray can be used for documentation. However, there is no coverage or payment for these services or for any other diagnostic or therapeutic service ordered or furnished by the chiropractor.

Resources for Coverage of Chiropractic Services:

  • CMS Medicare Benefit Policy ManualExternal PDFchapter 15, section 30.5 (Chiropractic Services)
    • For detailed information on using X-rays to determine subluxation, see section 240.1.2 of this manual

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