Medicare X-rays Coverage for Chiropractors

If you are on Medicare and you get X-rays taken by or for your chiropractor, you may need to watch your pocketbook starting in the near future. Chiropractors often take diagnostic X-rays when evaluating their patients, but since the year 2000, they have not been required to do so. Before then, if a chiropractor determined that her or his patient needed an "adjustment" (the hallmark of this treatment specialty), the burden of proof was on them, and they had to show - by means of x-rays that a subluxation existed in the patient’s spine. Because of that requirement, Centers for Medicare and Medicaid Services felt it was fair to reimburse patients for any radiology associated with chiropractic diagnosis (making an exception to the rule that all x-rays had to be ordered by patients’ primary physicians).

In 2000, the requirement to prove via x-ray that a spinal subluxation was present before administering chiropractic treatment was lifted. But the CMS continued to pay for diagnostic radiology provided by chiropractors just the same. Now they are proposing to do away with that reimbursement benefit.

Medicare is the largest payer of health care costs in the U.S. The proposed rule is accepting comments until August 31. On the CMS website, the file code for making comments is CMS-1385-P.

What the American Chiropractic Association Has to Say

“X-rays, when needed, are integral to the overall chiropractic treatment plan of Medicare patients, and unfortunately in the end, it is the beneficiary who will be negatively affected by this proposed change in coverage.”

The Rationale of the Center for Medicare and Medicaid Services

Because of the change that "removed the requirement that subluxation must be demonstrated by an x-ray, the chiropractic exception (allowing chiropractors to receive reimbursement for diagnostic x-rays) is no longer warranted. We do not believe it would be necessary or appropriate to continue to permit payment for an x-ray ordered by a nontreating physician when a chiropractor, not the ordering physician, will use that x-ray."