Medicare Archives

Medicare Diagnosis Rules

For Medicare coverage, there must be a diagnosis of subluxation, along with a secondary neuromusculoskeletal diagnosis in a spinal region. Medicare has, in recent years, allowed for a wider variety of secondary code to couple with the segmental dysfunction primary code. This brief training outlines the Medicare guidelines and requirements for diagnosis, both in the…

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Medicare’s Medical Necessity Reference Documents

Download Reference Documents Medicare publishes helpful documents and alerts to keep providers in the know about important topics. Included here are several documents that relate specifically to Chiropractic care and medical necessity. These tools relate to the proper use of the AT Modifier, Chiropractic documentation and the overall rulebook for Medicare policy, The Benefit Policy…

FAQ-Medicare Active vs. Maintenance Care

Active vs. Maintenance Care FAQs Q: If a Medicare patient moves from Medical Necessity treatment to Wellness and we have him/her sign an ABN, are we required to continue to bill Medicare with the appropriate modifier or can we convert the patient to cash? A: The ABN offers three options at the bottom of the…

Medicare’s Definition of Medical Necessity

The essence of medical necessity in Medicare is being able to prove that a subluxation exists, since the only coverage for chiropractic treatment is manual manipulation of the spine to correct a subluxation. However, a subluxation that is not associated with a secondary neuromusculoskeletal condition, and/or is not causing a loss of function may not…

Using PART as Part of your ROV Documentation

Documenting PART During Routine Office Visits The PART Process initials are an acronym for the required elements of examination that quantify the existence of a subluxation to meet Medicare requirements. The elements of PART are Pain, Asymmetry or Misalignment, Range of Motion Abnormalities, and Tissue Tone Changes. These elements are generally present in the initial…

Documenting PART in an Initial Visit Note

Using Clinical Judgement to Document PART Medicare requires that medical necessity be proven using the components of PART: Pain, Asymmetry, Range of motion, and Tissue tone changes. Two of these four elements must be present, and one must be Asymmetry or Range of motion. These are findings that are usually discovered during the initial evaluation…