Limited Coverage for Services Ordered or Furnished By a Chiropractor

This article is to remind chiropractors and facilities that X-rays and other diagnostic tests are statutorily excluded services when ordered or furnished by a chiropractor.

According to Medicare regulations at 42 CFR 410.21(b):

“(1) Medicare Part B pays only for a chiropractor’s manual manipulation of the spine to correct a subluxation if the subluxation has resulted in a neuromusculoskeletal condition for which manual manipulation is appropriate treatment. (2) Medicare Part B does not pay for X-rays or other diagnostic or therapeutic services furnished or ordered by a chiropractor.”

Services ordered by a chiropractor are considered statutorily excluded services and the beneficiary would be responsible for any charges incurred.

When X-rays or other diagnostic or therapeutic services, such as massage, ultrasound, and physical therapy are performed or ordered by a chiropractor and the provider elects to bill those services to Medicare, a GY modifier should be attached to that service. By using this modifier, the chiropractor is asserting that he/she knows that the service is noncovered by Medicare but is billing Medicare at the request of the beneficiary. Providers are required to bill noncovered services to Medicare when requested by the beneficiary. Claims billed with the GY modifier will be automatically denied by the Medicare claims processing system and the beneficiary will be liable for all charges, whether personally or through other insurance.

Reviewed 9/11/2024