Medicare Documentation: Think It's Subluxation-Based?

Published: 2011-03-08 15:05:28
Author: David Seaman, DC, MS, DABCN

  Despite the rumors to the contrary, it is very clear that the treatment of Medicare beneficiaries and subsequent Medicare documentation requirements are not subluxation-based.

How can one know this for sure? It is actually very easy. This fact is explained in all of the local coverage determinations (LCDs) for each region in the United States. All LCDs are based on Section 240 of the Medicare Benefit Policy Manual, which can be searched for by name and downloaded from the Internet as a PDF document. When you open the manual, the subtitle reads: Chapter 15 - Covered Medical and Other Health Services. Section 240 is devoted exclusively to chiropractic.


Prior to reading my LCD for Florida and Section 240, my impression was that the Medicare documentation was subluxation-based because that is what is often repeated. After reading these two documents, it becomes very clear that the treatment and documentation of Medicare patients is absolutely pain-based. As each LCD is slightly different, the information in this article comes directly from Section 240, which applies to all 50 states.

Section 240.1.3: Necessity for Treatment

Typical subluxation-based care is not based on pain or any other symptoms. Indeed, subluxation-based chiropractic is often described as non-therapeutic and even wellness care, a position that is in direct conflict with Medicare treatment and documentation requirements as outlined in Section 240 under the heading of Necessity for Treatment:
"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 reasonable expectation of recovery or improvement of function. The patient must have a subluxation of the spine as demonstrated by x-ray or physical exam, as described above."