It is important for Medicare recipients to understand the confusing regulations for receiving Chiropractic care. Most Medicare recipients believe that all services provided by participating providers (I have been participating in Medicare for my entire career; 40 plus years), would logically be a covered service.
However, this is not the case. Medicare ONLY COVERS CHIROPRACTIC ADJUSTMENTS TO THE SPINE AND PELVIS. Although Chiropractic Physicians are licensed to treat all body areas, for instance shoulders, knees, elbows, etc. treatment of extremities is not covered under Medicare.
Medicare only covers active acute or chronic conditions and specifically does not cover “maintenance care, “tune ups”, or preventative care. Thus, patients who opt for these types of visits would pay the Medicare fee for all services on that day of service. Medicare does cover conditions arising from a specific incident resulting in need for “active care” until that condition is resolved, at least stabilized until another episode requires additional care.
Furthermore Exams, X-rays (performed by a Chiropractor), physical therapy modalities, procedures, etc. (i.e.: Ultrasound, Electrical Stimulation, Manual Therapy, Exercise Therapy) are non-covered services under Medicare. Therefore, services in these categories are provided as necessary, but will be billed to the Medicare patient. The Adjustments are covered by Medicare, with a 20 percent copay, which is covered if the Medicare patient has a supplemental Medicare plan. (i.e.: AARP, United Health, Blue Cross, etc.). Supplemental plans do not cover services that Medicare does not cover.
You will be given a form know as an ABN, (advanced beneficiary notification) to read, choose an option, and sign. (Another point of confusion for many).
Many patients who “don’t want to be bothered” offer “I’ll just pay your fee”. It is considered illegal for a Chiropractor to treat a Traditional Medicare recipient and not bill Medicare. (i.e.: accept cash payment, check, credit card), except when they elect to pay and must sign and choose the “do not bill Medicare” option on the ABN form, but must understand and agree that they will not submit any receipts or bills to Medicare independently.
Another twist to this confusion is that Chiropractors are the only health care provider system that is not legally allowed to “opt out” of Medicare as many Medical doctors, (MD, DO) elect. Chiropractors must agree to bill Medicare whether they are “Participating or Non-Participating”, unless the patient instructs the DC to "not bill medicare."
I have elected to treat Medicare recipients. We will accept Medicare patients and bill Medicare, when that is your choice.
Please ask questions about the coverage prior to commencing care. We will offer a discount for seniors, for non-covered services.