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Dynamic Chiropractic – February 12, 2011, Vol. 29, Issue 04
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Dynamic Chiropractic

Billing Medicare for Instrument-Assisted Chiropractic Manipulation

By Samuel A. Collins

Q: I am thinking of using an Activator or a PulStar adjusting instrument for my chiropractic manipulation, but someone told me those type of devices are not reimbursable if used to treat Medicare patients.

My sources told me Medicare pays only for manipulation when performed by hand. Is this true?

A: I have had this very question raised several times recently based upon erroneous interpretation of a statement made by Noridian, a Medicare intermediary, on the use of devices for manipulation by chiropractors. The short answer is that those and other similar devices, if used to adjust Medicare patients, are reimbursable under the Medicare program. Medicare reimbursement for chiropractic services is limited to manipulation of the spine related to a vertebral subluxation. However, it does not indicate that this manipulation needs to be delivered by "hand," but only that it be delivered "manually." That statement, in and of itself, does not differentiate between manipulation by hand vs. by instruments such as Activator, PulStar, etc.

Specifically, the Centers for Medicare and Medicaid Services (CMS) states the following in its Medicare Benefit Policy Manual, Chapter 15, section 240.1 - Coverage of Chiropractic Services:

"Coverage extends only to treatment by means of manual manipulation of the spine to correct a subluxation provided such treatment is legal in the State where performed. In addition, in performing manual manipulation of the spine, some chiropractors use manual devices that are hand-held with the thrust of the force of the device being controlled manually. While such manual manipulation may be covered, there is no separate payment permitted for use of this device."

Based on these statements, Medicare reimbursable coverage is achieved if the manipulation is done by hand or handheld device. However, this handheld device must have the thrust controlled manually. Both the Activator and PulStar devices meet this requirement.

Therefore, should you or another doctor of chiropractic choose to use an adjusting instrument for the manipulation, rest assured it will be covered under Medicare as long as it is handheld and the thrust is manually controlled. As with any manipulation service, there should be documentation of the vertebral areas manipulated and the type/style of chiropractic used.

Feel free to submit billing questions to Mr. Collins at . Your question may be the subject of a future column.

Click here for more information about Samuel A. Collins.

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