X-ray of spinal vertebral subluxation. Source: Davis Family Chiropractic

As of Jan. 1, radiologists can no longer order x-rays for Medicare patients referred to them by chiropractors in a non-hospital setting.

The 2008 Medicare Fee Schedule Final Rule eliminated the chiropractor x-ray exception, which allowed non-treating physicians like radiologists to order diagnostic tests to identify a subluxation of the spine at the request of a chiropractor.

Before Jan. 1, 2000, the law required that an x-ray confirm the subluxation diagnosis for Medicare to reimburse for chiropractic corrections subluxations. Radiologists do not qualify under CMS rules as treating physicians who can order x-rays, and Medicare similarly restricts chiropractors from ordering x-rays. Therefore, the regulations provided a chiropractor exception.

In 2000, the law eliminated the requirement for x-ray confirmation of spinal subluxations. Yet, the exception remained in Medicare rules for eight years. CMS has now aligned its reimbursement policies with the 2000 statutory change. Now, CMS will no longer pay for x-rays or other diagnostic tests ordered by a non-treating physician to be used by chiropractors to demonstrate the subluxation.

The American Chiropractic Association (ACA) opposed the proposed rule to eliminate the chiropractor exception. The ACA argued that x-rays are essential to the chiropractic treatment plan of Medicare patients, the American College of Radiology (ACR) said.

CMS responded that x-rays are not needed to identify spinal subluxations, according to the ACR. CMS decided that this use fell outside the chiropractic exception.

CMS is currently evaluating the chiropractic services demonstration project that began on April 1, 2005, and ended on March 31, 2007, the ACR said. The demonstration project allowed chiropractors to provide services approved by CMS, including ordering diagnostic tests and therapies in Maine, New Mexico, Illinois, Iowa and Virginia.