Medicare Fees in the Chiropractic Office

How much you should bill to Medicare and how much you should collect from the patient is dependent upon several factors:

  • Is the doctor a participator
  • Is the doctor a non-participator not accepting assignment
  • Is the doctor a non-participator accepting assignment
  • What is the Medicare fee schedule for your state and region
  • Is Medicare traditional or an advantage plan
  • Is Medicare the only insurance
  • Is Medicare the secondary insurance
  • Does the patient have Medicare and Medicaid and if so are they in the QMB program
  • Is the patient working in a company that has over a certain number employees
  • Does the patient have Medicare but spouse is covered under their employer
  • Has the patient been in a motor vehicle accident
  • Did the patient sign an ABN
  • What if the patient has Part A only
  • Is the doctor following the Physician Quality Reporting System
  • Is the doctor using electronic health records (EHR)
  • Is the patient’s care active/corrective or maintenance

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