Providers of diagnostic tests and other services are reminded that Medicare Part B does not pay for x-rays or other diagnostic or therapeutic services furnished or directly ordered by chiropractors (42 CFR 410.22). Such services will be denied as not covered.
All diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests must be ordered by the physician who is treating the beneficiary for a specific medical problem and who uses the results in the management of the beneficiary’s specific medical problem. Tests ordered by a physician who is not treating the beneficiary for the specific medical problem are not reasonable and necessary (42 CFR 411.15(k)(1)). However, a chiropractic exception exists wherein a physician may order an x-ray to be used by a chiropractor to demonstrate the subluxation of the spine that is the basis for a beneficiary to receive manual manipulation treatments even though the physician does not treat the beneficiary (42 CFR 410.32). For example: a chiropractor may refer a beneficiary to a radiologist for x-rays of the spine, but the radiologist, and not the chiropractor, must order the x-rays. The beneficiary’s primary physician may also order the x-rays although he/she is not treating the beneficiary for the subluxation. The claim for the x-rays of the spine should include the radiologist’s or primary care physician’s UPIN as the ordering provider, and not the chiropractor’s UPIN.
The only tests that may be referred to and ordered by radiologists under this chiropractic exception are x-rays to demonstrate subluxation. “X-rays to demonstrate subluxation” is interpreted to mean plain radiographs of the various regions of the spine. Although they are diagnostic radiological tests, computerized tomography (CT) and magnetic resonance imaging (MRI) are not included as “x-rays” within this definition.
Chiropractors may not be the referring or certifying physician for therapy services provided by physical or occupational therapists in private practice. Chiropractors may refer patients for consultations to appropriate practitioners, but the consulting practitioner must send a written report to the referring chiropractor and involve him/her in the decision-making and subsequent care of the patient (as with all referring providers and consultations).