CMS drops chiropractor x-ray exception

Jan 23, 2008

Radiologists can no longer order x-rays for Medicare patients referred to them by chiropractors in a nonhospital setting, according to a January 1 ruling from the U.S. Centers for Medicare and Medicaid Services (CMS).

The American College of Radiology (ACR) of Reston, VA, reported that the 2008 Medicare Fee Schedule Final Rule has eliminated the so-called "chiropractor exception," which allowed nontreating physicians such as radiologists to order diagnostic tests to identify the subluxation of the spine at a chiropractor's request.

Prior to January 1, 2000, CMS required an x-ray to confirm the subluxation diagnosis for reimbursement of chiropractic adjustments to correct subluxations. Since radiologists do not qualify under Medicare rules as treating physicians who can order x-rays -- and chiropractors are similarly restricted -- the regulations provided an exception.

In 2000, CMS eliminated the requirement for x-ray confirmation of spinal subluxations, although the rule was not formally changed. CMS has now aligned its reimbursement policies with the 2000 statutory change, the ACR said.

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