Maintenance Care for Chiropractic Services
Contrary to popular belief, there are no limits on the number of adjustments a patient is allowed in the Medicare program in a year nor on the frequency of visits. Your Medicare Administrative Contractor (MAC) may have review screens (numbers of visits at which the MAC might require a review of documentation before allowing further care, but caps/limits are not allowed.
However, Medicare only allows services that are medically necessary. For chiropractic, this means that the patient must have “a significant health problem in the form of a neuromusculoskeletal condition necessitating treatment, and the manipulative services rendered must have a direct, therapeutic relationship to the patient’s condition and provide a reasonable expectation of recovery or improvement of function.”
In short, your documentation (histories, examinations, diagnosis and SOAP notes) must support medical necessity for your adjustments to be covered.
Under the Medicare Program, chiropractic maintenance adjustments are not considered to be medically reasonable or necessary and is therefore not payable. However, they are still considered to be covered services and must be filed.
Maintenance therapy is defined as a treatment that seeks to prevent disease, promote health, and prolong and enhance the quality of life; or therapy that is performed to maintain or prevent deterioration of a chronic condition. When further clinical improvement cannot reasonably be expected from continuous ongoing care and the chiropractic treatment becomes supportive rather than corrective in nature, the treatment is then considered maintenance therapy.
For additional information regarding maintenance therapy, refer to the Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 30.5.
A beneficiary should execute an ABN when a provider is performing maintenance therapy.
You may want to consider our Chiropractic Medicare Course