Medicare and chiropractic care (plan, supplement, coverage, patient)

[twelvepaw]

I have Medicare and a G supplement. Per their guidelines, Medicare pays for chiropractic care but not for the initial exam or x-rays. Over the past 5 years or so that I have had Medicare and the G supplement, I have regularly seen two different chiropractors (in different practices), and haven't had to pay a penny out of pocket (apart from Medicare deductible).

My chiropractor recently moved out of the area, so I am looking for a new chiropractor. I found one that came highly recommended, made an appointment, and completed the online insurance forms.They called me back and said that yes they take Medicare and my G supplement, but that there is only one billing code that Medicare accepts and I will be expected to pay the balance out of pocket. They said Medicare does not pay for manual adjustments or anything relating to a joint. I explained that I have seen two chiropractors over the past several years and never had to pay anything out of pocket for chiropractic care, but they insisted that they are billing per Medicare regulations.

So- I am really confused. Has anyone run into a complication like this with chiropractic treatment? Is this billing department just being really "diligent"? Or is this a sideways attempt at turning Medicare patients away? Or? I don't know how with my previous two chiropractors everything was covered, but now this new office says that essentially nothing is covered. It doesn't make any sense. Needless to say, I cancelled the appointment with them. Has anyone had a similar experience or can anyone explain what might have been going on.

[reed303]

Don't know what the old chiro's were doing, but here is what Medicare says:

"The only service ordered by a chiropractor that Medicare covers is manipulation of the spine to correct a subluxation"

See page 34 at https://www.medicare.gov/publication...re-and-You.pdf

Do you have old MSNs from Medicare to see how they billed ?

[ged_782]

Here is what I found online regarding Medicare and Chiropractic care:

"Medicare covers a chiropractor specifically for manual manipulation of the spine to correct a subluxation. Original Medicare (Parts A & B) does not cover other services or tests ordered by a chiropractor, such as X-rays, massage therapy or acupuncture."

I'm not sure why the same services covered at one provider would not be covered at another's practice, unless it is related to the billing codes they use. Some Advantage plans may provide for coverage of additional Chiropractic services beyond what Medicare will cover, but it doesn't sound like that applies to your situation.

[skeddy]

May have been some funny business going on at your old Chiropractic office.

[ged_782]

Originally Posted by skeddy

May have been some funny business going on at your old Chiropractic office.

Yeah, I was wondering about the same thing.

Given that original Medicare and Supplements don't have the oversight and prior authorization requirements that Advantage plans, (as well as non-Advantage commercial insurance plans) have, It's pretty much based on the biller's word.

[twelvepaw]

To clarify: my previous 3 chiropractors all used "manual manipulation of the spine to correct a subluxation" per the Medicare guidelines.
It was the "new" chiropractor's office that I spoke to today who said that Medicare doesn't cover manual manipulation, thus my request for any insight into why they would say that. The only thing I could think of was that they didn't want a Medicare patient even though they say they take Medicare; it was very strange.

[twelvepaw]

Originally Posted by ged_782

I'm not sure why the same services covered at one provider would not be covered at another's practice, unless it is related to the billing codes they use. Some Advantage plans may provide for coverage of additional Chiropractic services beyond what Medicare will cover, but it doesn't sound like that applies to your situation.

I thought it might be related to the billing codes too, and that they might be applying the billing codes differently so that Medicare only paid a portion and then the patient paid the balance but that certainly wouldn't foster good patient relations, so it still doesn't make sense.

And because I cancelled my initial appointment with them, I called another chiropractor's office, and specifically asked about any charges to the patient, and they said that Medicare patients with my coverage only pay for x-ray and initial exam.

I am ok with not having an explanation, but it was just weird.

[Ariadne22]

Fwiw, my chiropractor hates the Medicare paperwork. At one time, maintenance adjustments were not covered by Medicare, only treatments for acute issues.

I see the chiropractor 5-10 times a year for maintenance. This year it's been more often.

Been seeing this doc since 2005, began with a very debilitating sciatica issue partly covered by employer insurance. In those days insurance paid very little.

To keep things simple and avoid the Medicare hassle, I've been self-pay for years. Currently paying $47 a visit, just increased $2. I swear by this guy. Uses activator therapy, not 'manual' adjustments. No neck cracking or bone crunching. He does have Medicare patients, so no doubt they've found a way to bill.

[Roselvr]

I've seen a chiro regularly too, medicare always paid. My chiro said they gave a certain amount of visits per year. It never cost me anything out of pocket. The last time I went was maybe two years before COVID.