The Part B Medicare deductible for 2023 is $226.00. After the deductible is met, Medicare pays 80% of covered services that are considered medically necessary.
Manipulation of the spine is the only covered service for chiropractors by Medicare. All other services are not covered, and therefore, must be charged at your standard rate, unless the patient is a member of a discount medical program.
Medical necessity means that the treatment is intended to improve function.
To demonstrate an increase in function, one must use an accepted outcome assessment. Acceptable outcome assessment includes the Visual Analog Scale (VAS), outcome assessment tools (OATs) and range of motion (ROM) of the spine.
One must demonstrate more than just an improvement in pain. This means that one must show a reduction in function using tools such as a Range of Motion (ROM) Functional Rating Index (FRI), Neck Disability Index (NDI) or Oswestry Disability questionnaire.
When a patient reaches maximum improvement for a particular episode of treatment, they must be issue an Advanced Beneficiary Notice (ABN) which informs them that Medicare may not cover their treatment any longer. There is a new ABN for 2021.
NOTE: Federal law prohibits charging a patient for maintenance care until you properly administer the ABN. You can charge your normal fee for a manipulation after the ABN is properly administered.
Consider using HCPCS code S8990 for a maintenance manipulation. With the S8990 code, one can charge a single fee for maintenance manipulations.