Medicare Coverage of Chiropractic Services

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Chiropractic Resources

Code of Federal Regulations

• Code of Federal Regulations (Annual Edition) web page
  • 42 CFR Section 410.21 describes limitations on services of a chiropractor
  • 42 CFR Section 410.32 indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements)

Centers for Medicare & Medicaid Services

CMS Internet-Only Manuals

• CMS IOM Publication 100-01, Medicare General Information, Eligibility and Entitlement Manual, Chapter 5: 70.6 Chiropractors
• CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 15: 30.5 Physician Services – Chiropractor’s Services
• CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 15: 240 Chiropractic Services – General
• CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 220

CMS Medicare Learning Network^®

• MLN Matters^® SE1603 Revised: Educational Resources to Assist Chiropractors with Medicare Billing
• MLN Educational Tool^®: Medicare Documentation Job Aid for Doctors of Chiropractic
• MLN Matters^® SE1601 Revised: Medicare Coverage for Chiropractic Services – Medical Record Documentation Requirements for Initial and Subsequent Visits
• MLN Matters^® SE1602 Revised: Use of the AT modifier for Chiropractic Billing (New Information Along with Information in MM3449)
• Medicare Needs Better Controls To Prevent Fraud, Waste, and Abuse Related to Chiropractic Services – US Department of Health and Human Services

National Government Services

• NGS Medical Policies
  • LCD L33613 has been retired as of 12/31/2019 and can be accessed on the CMS Medicare Coverage Database. The LCD can remain as a document to provide billing guidance and coverage of medical necessity.
  • Local Coverage Article: Chiropractic Services – Medical Policy Article (A57889)

Revised 10/12/2023