I1865®5mythbustersThere is a myth circulating around the profession regarding a heavily promoted proposal to modify the section of the Medicare law pertaining to how a chiropractor is defined as a physician under the Medicare statute 1861(r)5.

What is being stated is as follows:

The “Myth”:

“The legislation we need would define DCs as “physicians” under the Social Security Act in the precise same way as MDs and DOs are defined. Achieving inclusion in the physician definition section of Medicare law identical to that of MDs and DOs would allow DCs to provide all medically necessary Medicare covered services that fall within their respective state scopes of practice and would impact many other federal programs such as workers compensation.”

It has been suggested that this “… proposal, if enacted, will mean that all Medicare patients will have coverage for all services, authorized under state law, provided or ordered by their doctor of chiropractic.”


It is time to separate “Fact” from “Fiction”.

Changing the language that defines a chiropractor as a physician “in the precise same way as an MD” would have absolutely no immediate impact on eligible reimbursements in the Medicare system for those services provided to Medicare beneficiaries by Doctors of Chiropractic. Here is why:

Changing the definition appropriately will remove the current restrictive language in the statute, however, it will only ENABLE the changes that could be made in Medicare regulations, NOT REQUIRE those changes. The limitations on coverage actually exist in Title 42 of the Code of Federal Regulations, Section 410.21(b) and are further defined in Chapter 15 of the Medicare Policy Manual, Section 30.5 and Section 240.1.1 .

Actual coverage determinations are dependent on published National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) which are developed based upon the published Medicare policies.

While the ICA is firmly committed to ending the discrimination in Medicare, it is also firmly committed to preserving current coverage for the adjustment to correct a subluxation.  The ICA Board was recently asked to review and approve a proposal that included the following enacting clause:

(a) IN GENERAL.—Clause (5) of section 1861(r) of the Social Security Act (42 U.S.C. 1395x(r)) is amended to read as follows: ‘‘(5) a doctor of chiropractic legally authorized to practice chiropractic by the State in which he or she performs such functions or actions who is acting within the scope of his or her license when he or she performs such functions or actions,”

Doing so, however, would delete the existing clause:

“(5) a chiropractor who is licensed as such by the State (or in a State which does not license chiropractors as such, is legally authorized to perform the services of a chiropractor in the jurisdiction in which he performs such services), and who meets uniform minimum standards promulgated by the Secretary, but only for the purpose of sections 1861(s)(1) and 1861(s)(2)(A) and only with respect to treatment by means of manual manipulation of the spine (to correct a subluxation) which he is legally authorized to perform by the State or jurisdiction in which such treatment is provided.”

The proposal was rejected unanimously by the ICA Board.  The ICA is emphatically opposed to any legislative language that eliminates the only reference that ensures that the chiropractic adjustment is considered a covered service.

Removing the word “only” would also remove the current restriction and enable, but also not require, changes in the Code of Federal Regulations.

See  Changing Medicare Regulations for a more in depth explanation.


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