Is there or isn’t there a 12 visit cap for Chiropractic Services? Do you know for sure?
Obviously from the title we’re calling this one out as a myth, and here’s the straight scoop right from the Centers for Medicare & Medicaid Services (CMS). If you treat Medicare patients you really have to have this information “exactly” right.
There are no caps/limits in Medicare for covered chiropractic care rendered by chiropractors who meet Medicare’s licensure and other requirements as specified in the Medicare Benefit Policy Manual, Chapter 15, Section 30.5. (This manual is available at http://www.cms.hhs.gov/manuals/IOM/list.asp on the CMS website.) There may be review screens (numbers of visits at which the Medicare Carrier or A/B MAC may require a review of documentation), but caps/limits are not allowed.
There you have it, 6 more myths to go!
{ 2 comments… read them below or add one }
I find no support for your Myth bust in the Manual that you have sited. From our experience, CMS will tell you and will deny visits over 12 in a month.
Hi Christy,
A good point about the citation, it is odd choice of citation in this context though no reference was made to a time frame of one month. The area of the post next to the vertical line is actually taken directly from a CMS document, as I was trying to avoid any misstatements on my part. The citation mentioned was about meeting the license requirements for Medicare, not for visit caps. Perhaps it was chosen because it does in turn cite other areas of the manual that do speak to “Treatment Parameters” (240.1.5) and “Necessity for Treatment” (240.1.3).
The discussion in those sections keys on differentiating between maintenance treatment and treatment that is a necessity, not a specific cap on number of visits. The only number cap I found was a limit of one visit per day as a maximum allowed. I’ve seen Medicare experts mention a process for avoiding the rejections you’ve encountered and would invite anyone who knows more on this specific topic to share what they know so we can have clear direction on dealing with this issue.