Billing and Coding: Chiropractor Services

Medicare covers chiropractic spinal manipulation when the primary diagnosis is a spinal subluxation (with level specified) and the medical record documents that the service is reasonable and necessary. Documentation must include detailed history, a focused physical exam demonstrating required subluxation criteria (two of four findings, one being asymmetry/misalignment or ROM abnormality), a treatment plan with goals and frequency/duration, and appropriate documentation for subsequent visits; services lacking required documentation or medical necessity are subject to denial and coding edits (CCI).

"Chiropractic spinal manipulation is covered when the primary diagnosis is a spinal subluxation and the medical record documents that the service is reasonable and necessary."

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