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Published February 20, 2020
By Wyn Staheli, Director of Research
In the ChiroCode Newsletter released yesterday regarding Medicare coverage of acupuncture, one sentence in particular has let to some confusion. Specifically, "However, the way that it is currently worded, a chiropractor cannot ‘order’ acupuncture, BUT they may provide the services as an auxiliary provider as long as it is ordered by a physician meeting their requirements."
To be clear, a Doctor of Chiropractic can not perform the acupuncture service through their chiropractic license, even if they have taken the NBCE exam for acupuncture and possess a certificate for acupuncture for their state, regardless of whether there is a physician referral. They may only perform the service if they meet ALL the 'auxiliary personnel' requirements listed in the box that follows the opening paragraph.
We have since made a revision to the original article to make this clear. The original sentence has been revised to say (change is underlined) "However, the way that it is currently worded, a chiropractor cannot ‘order’ acupuncture, BUT they may provide the services as an auxiliary provider as long as it is ordered by a physician and meets ALL the NCD requirements."
Further, we have added an "Update" at the end which enumerates the three key elements necessary to meet Medicare's requirements. It states:
In summary, you must meet ALL three of the following requirements:
A masters or doctoral level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine (ACAOM)
A current, full, active, and unrestricted license to practice acupuncture in your state (includes territory, or commonwealth (i.e. Puerto Rico) of the United States, or District of Columbia)
As an 'Auxiliary personnel' the chiropractor must be under the appropriate level of supervision to meet Medicare's 'incident to' requirements
If you do not meet ALL three requirements, you are not eligible to perform acupuncture on a Medicare beneficiary. Please keep in mind that this is only for Medicare and individual payer policies and/or state requirements may vary from the information presented in the article.
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About This Tool
The Basic Medicare Fee Calculator is a helpful tool which uses Resource Based Relative Value Units (RBRVS) to estimate fees. It is only for educational purposes and should not be used as your only source for fee schedule determinations. The percentages included here should only be used as a reference and should be adjusted to fit your individual needs. Please note that some states, such as Florida, mandate specific percentages of the Medicare Fee as the allowed amount for personal injury or other claims.
Enter your zip code and click on the [Create Fee Worksheet] button. Geographic adjustments will be applied to the displayed Medicare Fee. The Medicare Fee displayed is the Allowed Amount. To find the Medicare limiting charge for non-participating providers, consult your Medicare Administrative Contractor.
By providing this tool, ChiroCode does not guarantee or assure correct use and application of fees and or codes to users or any other party. Reasonable effort has been made to verify the accuracy of this tool. The regional Medicare fees used as a foundation for this tool are believed to be accurate and current. Absolute accuracy though of this tool or the use of this tool cannot be guaranteed. ChiroCode will be held harmless of any and all liability arising from fee schedule establishment or management based upon the use of this tool. This tool is not endorsed by the American Medical Association (AMA).
Find-A-Code is dedicated to providing the most complete medical coding and billing resource library available anywhere. Find-A-Code's online libraries include extensive information for all major code sets along with a wealth of supplemental information.
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For over 25 years, ChiroCode has led the way in helping the chiropractic profession with coding and reimbursement issues. Our mission is to help chiropractors and their staff get the information they need to run a successful and compliant practice.
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Patient documentation is the foundation of every patient visit in chiropractic practices. It establishes and supports the need for patient care. It is also one of the most highly cited problems by the OIG. Providers must have thorough documentation that adequately meets medical necessity requirements in order to receive and keep third-party reimbursement. Documentation requirements can seem daunting. However, with the help of ChiroCode, documenting correctly for new and established patient visits, consultations, daily visits, therapies, and products supplies can become more clearly understood and more efficient.
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