The Medicare policies are developed with a high level of discretion on the part of the Centers for Medicare and Medicaid Services (CMS), however, they must be consistent with the Code of Federal Regulations.
Most of the policies governing reimbursements to Medicare beneficiaries for services provided by Doctors of Chiropractic can be found in Chapter 15 of the Medicare Policy Manual.
CMS has published a booklet that describes these policies. Medicare claims processing policies are contained in Chapter 12.
Over the years there has been a tremendous amount of mis-information distributed with the chiropractic profession regarding Medicare. CMS has published a booklet addressing some of the common misconceptions.
Chapter 15 Medicare Policy Manual is a compilation of 292 pages devoted to defining all of the regulations associated with each service that is reimbursable in the Medicare system.
The concept that an MD and/or a DO is reimbursed for all services that is within their scope of practice as defined in their state law is pure fantasy.
Section 1861(r)5 is not the only section of Medicare law that is used by the regulators to limit the services reimbursable to patients of chiropractors.
Changing 1861(r)5 will not guarantee any additional reimbursements. The modification actually would only enable the regulators to add additional covered services that are not limited elsewhere in statute. What will surprise many is that reimbursement for x-rays is also limited by regulations and policies that state:
“No other diagnostic or therapeutic service furnished by a chiropractor or under the chiropractor’s order is covered. For instance, if a chiropractor orders, takes, or interprets an x-ray, or any other diagnostic test, the x-ray or other diagnostic test, can be used for claims processing purposes, but Medicare coverage and payment are not available for those services. This prohibition does not affect the coverage of x-rays or other diagnostic tests furnished by other practitioners under the program. For example, an x-ray or any diagnostic test taken for the purpose of determining or demonstrating the existence of a subluxation of the spine is a diagnostic x-ray test covered under Section 1861(s)(3) of the Social Security Act if ordered, taken, and interpreted by a physician who is a doctor of medicine or osteopathy.”