WASHINGTON, D.C. -- In response to inquiries from the American Chiropractic Association (ACA), the Health Care Financing Administration (HCFA) has clarified the procedure to be followed when a Medicare patient refuses to have an x-ray taken or when a doctor believes an x-ray is not appropriate for the Medicare patient. The letter states:
"Section 1861 (r) (5) of the Social Security Act requires that an x-ray demonstrate subluxation of the spine in order for chiropractic manipulation of the spine to be covered under the Medicare program. When this x-ray is not provided, coverage is denied, any claim for chiropractic manipulation is not paid by the program, and the beneficiary is held liable. Thus, in response to your question as to the patient refusal to permit the x-ray, this is denied as an uncovered service. The claim will be denied as a statutory denial, the beneficiary is liable for payment and the chiropractor may bill the patient directly for the manipulation service. "If the x-ray is not taken because the chiropractor believes it is not appropriate for the specific patient, the manipulation is also considered an uncovered service. As in the first case, this claim denial is based on section 1861 (r), the patient is responsible for payment, and the chiropractor may bill the beneficiary directly."In the above two circumstances, the doctor should submit the claim for manipulation utilizing the A9170 code (non-covered service by a chiropractor) in order for the correct denial notification to be generated by the carrier. This procedure is effective until January 1, 2000 when the X-ray requirement under Medicare is eliminated. Doctors of chiropractic with questions on this billing procedure should call Sheri Herren, of ACA's Department of Professional Development and Research at (800) 986-4636, ext. 242.