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The Truth about Medicare and Chiropractic Care

on : November 14, 2015 comments : (0)

medicare and chiropractor idaho falls You may have heard some misconceptions of what Medicare covers and what they do not when it comes to chiropractic care. Advanced Health Chiropractic and Massage Center in Idaho Falls has provided some need to know facts about Medicare and chiropractic care that you need to know about.

First let’s discuss Medicare. What is it exactly?

Medicare is a federal health insurance program meant for:

  • Individuals 65 or older.
  • Individuals under 65 with certain disabilities.
  • Individuals of all ages with End Stage Renal Disease.

When medically necessary a Medicare Part B Medical Insurance plan will cover limited chiropractic care.

Disclaimer: The facts you will find below were provided by Medicare & Medicaid Services (CMS). These facts are informational and do not reflect any changes that may be made to the existing Medicare policy.

I heard there was a 12 visit limit for chiropractic care

Limits and caps are typically not allowed when care is being rendered by chiropractors who meet Medicare’s licensure and requirements stated in the Medicare Benefit Policy Manual.

With the exclusion of Alabama, Medicare will only pay for 25 chiropractic adjustments per individual in a 12 month period. This 12 month period is not a calendar year but 12 months from the initial visit.

Nonparticipating providers don’t have to bill Medicare

This is incorrect. All Medicare Part B services that are covered must be billed to Medicare by the provider or they will be subject to penalties. A non-par provider, or an individual who has enrolled to be a provider of Medicare but has chosen to receive payment through a different method and amount than what Medicare provides. These providers may receive reimbursement for services rendered directly from Medicare patients; however, they still have to submit a bill to Medicare so the beneficiary may be reimbursed for the portion of charges that Medicare is responsible for.

Medicare doesn’t cover maintenance care

Medicare doesn’t consider maintenance care medically reasonably or necessary so maintenance care is not reimbursable. Medicare does consider spinal manipulation a covered service. Only acute and chronic spinal manipulation services are considered active care and are reimbursable.

What exactly is maintenance care?

Maintenance care is defined by Medicare as: “service that seek to prevent disease, promote health, prolong and enhance quality of life, or maintain or prevent deterioration of a chronic condition.” Usually maintenance care starts when you have reached your MMI (Maximum Medical Improvement). That is only when chiropractic care is not expected to improved your condition, only maintain your current level of improvement.

Medicare does not cover the following:

  • New Patient Exams
  • X-Rays
  • Re-exams and Therapies
  • Extra-spinous Adjustments

I heard Medicare doesn’t have a deductible

In fact, Medicare does require a deductible of $147 be paid annually before they will pay for any claims. This deductible is for all Medicare Part B coverage. There is also a small coinsurance amount due when you get a chiropractic adjustment visit. If you have one, most supplemental or secondary insurance policies will pay that coinsurance.

At Advanced Health Chiropractic and Massage Center in Idaho Falls we hope the facts provided were informational and were able to help you. If you have any questions or concerns about chiropractic care and Medicare call Advanced Health Chiropractic and Massage Center in Idaho Falls today!



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