The term “physician” under Part B includes a chiropractor who meets the specified qualifying requirements.
Effective for claims with dates of services on or after January 1, 2000, an x-ray is not required to demonstrate the subluxation.
Implementation of the chiropractic benefit requires an appreciation of the differences between chiropractic theory and experience and traditional medicine due to fundamental differences regarding etiology and theories of the pathogenesis of disease. Judgments about the reasonableness of chiropractic treatment must be based on the application of chiropractic principles. So that Medicare beneficiaries receive equitable adjudication of claims based on such principles and are not deprived of the benefits intended by the law, carriers may use chiropractic consultation in carrier review of Medicare chiropractic claims.
Payment is based on the physician fee schedule and made to the beneficiary or, on assignment, to the chiropractor.
Verification of Chiropractor’s Qualifications
Carriers must establish a reference file of chiropractors eligible for payment as physicians under the criteria in §30.1. They pay only chiropractors on file. Information needed to establish such files is furnished by the CMS RO.
The RO is notified by the appropriate State agency which chiropractors are licensed and whether each meets the national uniform standards.
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