The Part B Medicare deductible for 2018 is $183. After the deductible is met, patients pay 20% of the Medicare approved amount for covered services that are medically necessary.
Manipulation of the spine is the only service that is covered by Medicare. All other services are not covered, therefore, they can be charged at your normal rate.
Medicare only covers services that are medically necessary. For chiropractors, this means manipulations that increase function.
To demonstrate an increase in function, one must use an acceptable outcome measures. Acceptable outcome measures includes the Visual Analog Scale (VAS), outcome assessment tools (OATs) and range of motion (ROM) using inclinometers.
You must demonstrate more than just an improvement in pain. This means that you must show a reduction in function using tools such as a Functional Rating Index (FRI), Neck Disability Index (NDI) or Oswestry Disability questionnaire.
When the patient reaches maximum improvement for a particular episode of treatment, you must issue an Advanced Beneficiary Notice (ABN) to inform them that Medicare may not cover their treatment any longer. There is a new ABN for 2018.
Click here to open the CMS link for the 2018 Spanish and English versions of the ABN.
Click here to open the ABN instructions.
REMEMBER! ONLY GIVE THE ABN WHEN THE PATIENT REACHES MAXIMUM IMPROVEMENT.
THE ABN IS NOT REQUIRED ON THE FIRST VISIT!