Demonstration of Expansion of Coverage for Chiropractic Services Applicable to Limited Geographic Areas
Beginning April 1, 2005, CMS is conducting a demonstration to evaluate the feasibility and advisability of expanding the coverage of diagnostic and other chiropractic services under Medicare. This demonstration is required by Section 651 of the Medicare Modernization Act of 2003 (MMA). Chiropractors must be providing these services in the demonstration areas specified in CMS Medlearn Matters article SE 0514 which can be accessed by clicking here. (pdf - 20 pages; 412KB) For Chiropractors in this area there is no requirement to enroll in the demonstration in order to bill for the additional demonstration services.
The demonstration will be conducted in four geographic areas-two rural and two urban. One rural and one urban geographic area will be located in a designated Health Professional Shortage Area (HPSA). These areas are the states of Maine and New Mexico, Scott County, Iowa, 26 counties in Illinois (including Cook, DeKalb, DuPage, Grundy, Kane, Kendall, McHenry, Will, Boone, Bureau, Carroll, Henry, JoDaviess, Kankakee, Lake, LaSalle, Lee, Marshall, Mercer, Ogle, Putnam, Rock Island, Stark, Stephenson, Whiteside, and Winnebago counties), and 17 counties in central Virginia. While you will only be able to participate if you provide services in the four designated geographic areas, your Medicare patients are not required to live in these areas to receive demonstration services. In addition, chiropractors practicing within the demonstration areas may refer patients to providers that are not located in the demonstration areas.
Doctors of chiropractic will be able to bill Medicare carriers for the Part B medical, radiology, clinical lab, and therapy services related to the treatment of neuromusculoskeletal conditions that you are legally permitted to provide according to your state practice acts, and as allowed within Medicare rules. Chiropractors can order MRIs and CT scans under the demonstration; however they cannot be paid to perform or interpret them. In addition, chiropractors participating in this demonstration will be able to order x-rays and clinical lab services.
Coverage will also be expanded to include other ancillary services chiropractors are legally allowed to provide and Medicare currently covers. These procedures include electrotherapy, ultrasound, TENS therapy, and other services that are medically necessary for the treatment of neuromusculoskeletal conditions. Chiropractors will be allowed to provide physical therapy services and to refer patients for therapy under this demonstration. Chiropractors will also be reimbursed for Evaluation and Management (E&M) services delivered for neuromusculoskeletal conditions.
WPS Medicare will host more than a dozen seminars on this demonstration in the affected areas. Sign up for our Chiropractic-specialty Medicare e-News today and keep up to date on all these exciting changes!
Page Last Updated: Monday, 09-Jun-2008 13:34:39 CDT
