Ask the Expert: Medicare

Question: Do Chiropractors Have to Bill Medicare?

Answer: According to the Medicare billing guide (sections 40 thru 40.4); the answer is a resounding Yes. Medicare requires all physicians who have not opted out of Medicare must bill for covered services provided to a Medicare patient, on the behalf of the patient. Even a non par provider not accepting assignment must submit the claim to Medicare on behalf of the patient. It also says that Chiropractors are not qualified as physicians who can opt out of Medicare. So, yes, you have to bill for covered services.

Now let's define covered services. Covered services are defined as those services listed in your Medicare LCD, or Medicare Chiropractic Billing Guide, as being covered by Medicare and are medically necessary. For chiropractic this is 98940, 98941 and 98942, for the time being. Therefore spinal manipulation must be billed to Medicare by the doctor of chiropractic. Any codes other than the three spinal manipulation codes are excluded from being covered when provided by a chiropractor, i.e. exams, x-rays, extraspinal adjustments etc. and are not required to be billed to Medicare unless there is a secondary payer to Medicare who will cover those services.