US Medicare Blocks Physical Therapists from Performing Chiropractic Adjustments

The U.S. Department of Health and Human Services issued a letter dated January 15, 2002 which was a reversal from their previous position dating back to December 14, 1994 that had allowed Physical Therapists (PTs) to perform chiropractic services under the US Medicare law. With the new ruling, PT's are not allowed to do chiropractic procedures under Medicare.

In actuality there was never an abundance of PTs performing chiropractic adjustments. But the ruling as it previously was in the past allowed certain HMOs and insurance companies to exclude Doctors of Chiropractic from their provider lists because they claimed they were offering required chiropractic services when needed through their Physical Therapists. With this new letter and ruling, all Medicare insurance companies and HMO's will not be able to use PT's as an excuse not to have chiropractors on their provider lists.

The chiropractic profession has been fighting this problem for years with both legislation and an ongoing lawsuit. This ruling does not completely fix the problems but it is viewed by most as a good first step toward protecting the public and making chiropractic care available to Medicare beneficiaries without undue harassment.

The letter itself stated: "Section 1861(r) of the Social Security Act provides the definition of a physician for Medicare coverages purposes, which includes a chiropractor for treatment of manual manipulation of the spine to correct a subluxation. (As a standard Medicare Part B benefit, manual manipulation of the spine to correct subluxations must be made available to enrollees in all Medicare + Choice plans) The statute specifically references manual manipulation of the spine to correct a subluxation as a physician service. Thus, Medicare + Choice organizations must use physicians, which include chiropractors, to perform this service. They may not use non-physician physical therapists for manual manipulation of the spine to correct a subluxation."