The Endless Medicare Saga

This section was compiled by Frank M. Painter, D.C.
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Lobbying Effort Puts Medicare Caps on Chiropractic Care on Hold
November 4, 2004   ARLINGTON, Va. -  In response to concerns raised by the American Chiropractic Association, Iowa Sen. Chuck Grassley and a bipartisan group of members of Congress, Health and Human Services (HHS) Sec. Tommy Thompson stopped a Centers for Medicare and Medicaid Services (CMS) proposal from going into effect Oct. 1. Had the proposal been implemented as planned, it would have allowed insurance carriers to begin to impose arbitrary caps, or "frequency limits," on the chiropractic services Medicare beneficiaries can receive. HHS officials informed the ACA on Oct. 1 that the proposal would not go into effect, and that it would be reviewed further at the department's highest level.

The Medicare Maze
July 14, 2003   As practicing doctors of chiropractic, we are rightfully justified in our anger and frustration regarding the limited reimbursement and authority we face under Medicare. However, a number of key points must be considered regarding any attempt to fairly "evaluate" this matter, and the potential of the chiropractic profession to resolve it favorably. This is serious for all of us, so I would like to provide you with a thoughtful, candid and detailed assessment of the relevant issues at hand.

Congressional Committee Slams Medicare for Harassment of Providers
On May 16th, 2002, before a packed hearing room, Small Business Committee Chairman Donald Manzullo (R-IL) and more than a dozen other members of the U.S. House of Representatives, pounded Medicare Administrator Thomas Scully for that program's ongoing policy of provider harassment.

Mid-Year (2002) Review of the ACA Lawsuits
Since January of this year, several events have moved the ACA's lawsuits against the Department of Health and Human Services and Trigon Blue Cross Blue Shield of Virginia forward in positive directions for chiropractic. Following is a synopsis of significant developments:

CMS Announces Change in CCI Edits at ACA's Urging:
The Centers for Medicare & Medicaid Services (CMS) has announced changes in its National Correct Coding Initiative (NCCI) that will allow doctors of chiropractic to use codes for procedures such as manual therapy (CPT Code 97140) when billed on the same date of service as a chiropractic manipulative treatment (CMT) code.

Alabama DCs Bring Suit against Blue Cross/Blue Shield
April 9, 2001
  Ten Alabama DCs have filed suit against Blue Cross and Blue Shield (BC/BS) of Alabama for discriminating against chiropractors. The plaintiffs allege two antitrust violations of the Sherman Act: restraint of trade or commerce in an agreement with HealthSouth Corp., and monopolizing or attempting to monopolize health care reimbursement services in Alabama.

U.S. Federal Court Rules against HHS Attempt to Dismiss ACA Lawsuit
January 22, 2001 --
  The U.S. District Court ruled that under the applicable standards established by the United States Supreme Court, the ACA is entitled to bring its claim before the federal bench. ACA President Dr. James Mertz commented: "The ACA has argued the reasonable proposition that chiropractic services should be provided by doctors of chiropractic, because they are the only providers licensed, trained, and educated to perform manual manipulation of the spine to correct a subluxation. Now we will have an opportunity to argue our position before a federal court and not be bogged down in internal administrative gridlock."

ACA Files Major Lawsuit against Trigon Blue Cross/Blue Shield
August 18 , 2000 -   ARLINGTON, VA --
  The American Chiropractic Association, the Virginia Chiropractic Association (VCA), five doctors of chiropractic, and 18 chiropractic patients filed suit on August 18 in the U.S. District Court against the largest managed health care company in the state: Trigon Blue Cross/Blue Shield (BC/BS), BC/BS Association, et al. The suit alleges racketeering, extortion, mail fraud, antitrust violations, and other state and federal law violations.

U.S. Federal Court Rules American Chiropractic Association Has Standing to Sue HHS Over Medicare+Choice
July 14, 2000 -   ARLINGTON, VA --
  In an enormous breakthrough for the American Chiropractic Association (ACA), the U.S. District Court for the District of Columbia has ruled that the ACA has standing to sue the U.S. Department of Health and Human Services (HHS) over recent Medicare+Choice guidelines that the ACA says have virtually excluded chiropractic services from the Medicare managed care program. Read the 19-page opinion.

Government Report on Medicare HMOs Shows Recuction in Chiropractic Services
July 3, 2000 -   WASHINGTON, DC --
  A new government report on the utilization of chiropractic care in Medicare managed care plans reveals a "startlingly unexplainable reduction" in chiropractic services available to beneficiaries - especially to patients enrolled in Medicare HMOs that require a physician referral to a chiropractor, according to the American Chiropractic Association (ACA).

ACA Fights Medicare Review after 12 Treatments: Seeks Optional Review at 18 Visits, with Mandatory Review at 24 Visits
November 15, 1999 -
  The American Chiropractic Association (ACA) recently requested a meeting with the Health Care Financing Administration (HCFA) after learning that the Office of Inspector General (OIG) had recommended that chiropractic care of Medicare patients continue to be screened (reviewed) after 12 visits.

NY Senate Bill Passes -- Only DCs and MDs Can Do Spinal Manipulation
On June 17, 1999, the New York State Senate passed Senate Bill S06003 to amend Section 6551 of the New York Education Law to allow only licensed DCs and MDs in the Empire state the legal authority to perform spinal manipulation. The vote was 58-1 in favor of the bill.

HCFA Official Says PTs Can't Bill Medicare for Manipulation to Correct Subluxation
July 12, 1999
  The Practicing Physicians Advisory Council (PPAC) meet June 14 with various officials of the Health Care Financing Administration (HCFA) at the HCFA headquarters in Baltimore, Maryland. The PPAC, a 15-member group of physicians appointed by the Secretary of Health and Human Services, meets quarterly to discuss proposed changes in regulations related to physician services. The sole chiropractic member of the PPAC is Jerilynn Kaibel of San Bernardino, California.

Medicare's Change in Policy Concerning the Provision of Manual Manipulation of the Spine to Correct a Subluxation by a Physical Therapist
There has been much confusion as to HCFA's change in policy as it relates to the provision of the above Medicare physician service by physical therapists. The following is a chronology along with supportive documents that clearly reflects the change. ACA has filed suit against HHS Secretary Shalala that alleges that only doctors of chiropractic are authorized under Medicare laws to manipulate the spine to correct a subluxation. The following information, prepared by ACA legal counsel Tom Daly, deals with a subset of that proposition - namely, physical therapist's eligibility to deliver the service.

Senator Thurmond Questions Shalala's Report: Asks Her to Respond to Chiropractic Being Shut out of Medicare Managed Care
June 28, 1999
  Senator Strom Thurmond (R-SC), a long-time political friend of chiropractic, has taken exception with Secretary of Health and Human Services Donna Shalala. In his pointed letter to Sec. Shalala (reprinted in full below), Senator Thurmond lays out his concerns over the snubbing of chiropractic services under the new Medicare managed care program.

House Medicare Resolutions Introduced to Protect Chiropractic Turf and Increase Scope of Practice
May 3, 1999
  As reported in previous issues of Dynamic Chiropractic, the American Chiropractic Association (ACA) has warned that the new Medicare+ Choice regulations of the Health Care Finance Administration (HCFA) threaten to curtail or eliminate chiropractic services by sending patients to PTs or MDs for adjustments. And because the new Medicare regulations are in essence the government's managed care plan for seniors, the ACA further warns that managed care plans across the country will follow the federal example.

Blue Cross Drops Chiropractic for Seniors in N. California
February 22, 1999
  "Our worst fears are now coming true," is how ACA President Michael Pedigo, DC, reacted to the news that Blue Cross will no longer cover chiropractic under its Senior Secure Plan in Northern California. "We have been warning the profession for some time now that the new Medicare+Choice regulations could seriously threaten chiropractic. This is another concrete example of chiropractic services being dropped from a Medicare managed care plan."

ACA Files Suit against HCFA for Medicare Part C
January 1, 1999
  November 12th, 1998 was an important day for our profession. ACA took a bold, courageous step in protecting the future of our profession and the rights of Medicare patients to have chiropractic care as mandated by Congress. ACA filed a lawsuit against HCFA over their illegal regulations in Medicare Part C, which will go into effect in January 1999 if we don't stop them. They are perpetuating an illegal regulation they established under Medicare Part B.

ACA Lawsuit against HCFA Now Online at
January 1, 1999
On November 12th, 1998, the American Chiropractic Association filed a lawsuit in U.S. District Court against the Department of Health and Human Services. (See "Chiropractic on the Medicare Chopping Block?" DC, Nov. 2, 1998 and "ACA Files Lawsuit against HCFA" DC Dec. 14, 1998). The suit was filed as an effort to block impending Health Care Financing Administration (HCFA) regulations governing Medicare Part C programs. The lawsuit is located at

Chiropractic on the Medicare Chopping Block
November 2, 1998
  Chiropractic and Medicare: It's been one long battle. First, the chiropractic profession had to fight to be included under Medicare; then chiropractic had to fight to get rid of the x-ray requirement to demonstrate the existence of a spinal subluxation before treating a patient; and now chiropractic is fighting to keep Medicare patients from being sent to the MDs, osteopaths and PTs for spinal manipulation.

ACA Will Challenge Legality of Medicare Regulations
February 24, 1997
  ACA President Dr. Kurt Hegetschweiler: "The lawsuit represents the final straw in years of behind-the-scenes efforts to lobby the Dept. of Health and Human Services for changes in HCFA's regulatory policy toward the chiropractic profession."


House Resolution 1046

In 1972, the Medicare statute defined DCs as physicians, but only for the purpose of "manual manipulation of the spine to correct a subluxation" (sec. 1861(r)(5) of the Social Security Act). This limited definition of chiropractic care has severely limited Medicare beneficiaries from seeking many services that DCs are licensed to perform.

On March 10, Representative Wes Watkins (R-OK) introduced the Chiropractic Patient's Freedom of Choice Act (HR 1046) on the floor of the U.S. House of Representatives. The act would amend Title XVIII of the Social Security Act to provide reimbursement for all physician services for doctors of chiropractic within the scope of their license under the Medicare program.

The language of HR 1046 reads:

"(5) a doctor of chiropractic who is licensed as such by the State and who meets uniform minimum standards promulgated by the Secretary, with respects to treatment by means of manual manipulation of the spine to correct a subluxation, and related diagnostic and therapeutic services as identified in subsection (s), but only with the respect to functions which he or she is legally authorized to perform by the State in which he or she performs such functions."

For more information, contact the ACA by phone at (800) 986-4636


The Actual Bill

Chiropractic Patients' Freedom of Choice Act of 1999

(Introduced in the House)

HR 1046 IH


1st Session

H. R. 1046

To amend title XVIII of the Social Security Act to provide reimbursement under the Medicare Program for all physicians' services furnished by doctors of chiropractic within the scope of their license.


March 9, 1999

Mr. WATKINS introduced the following bill; which was referred to the Committee on Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned



To amend title XVIII of the Social Security Act to provide reimbursement under the Medicare Program for all physicians' services furnished by doctors of chiropractic within the scope of their license

. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,


This Act may be cited as the `Chiropractic Patients' Freedom of Choice Act of 1999'.


(a) IN GENERAL- Clause (5) of section 1861(r) of the Social Security Act (42 U.S.C. 1395x(r)) is amended to read as follows: `(5) a doctor of chiropractic who is licensed as such by the State and who meets uniform minimum standards promulgated by the Secretary, with respects to treatment by means of manual manipulation of the spine to correct a subluxation, and related diagnostic and therapeutic services as identified in subsection (s), but only with the respect to functions which he or she is legally authorized to perform by the State in which he or she performs such functions.'.

(b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to services furnished on or after January 1, 2000.


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