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

The Centers for Medicare & Medicaid Services (CMS) is proposing to eliminate reimbursements to patients for x-rays taken by an MD or doctor of osteopathic medicine (DO), and used by a chiropractor to determine a subluxation.

The American Chiropractic Association (ACA) said it is prepared to fight the change and is urging all chiropractors to submit comments on the proposed regulation. Comments must be submitted by Aug. 31.

In 2000, the requirement for x-rays to justify spinal manipulation to remove subluxation was eliminated. However, the ACA said x-rays remained a covered service if ordered by an MD or DO and the x-ray service is still recognized as an option to identify the subluxation.

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

According to the ACA, by limiting chiropractors from referring to an x-ray study, the costs for patient care will go up significantly because of the necessity to refer patients to another provider for duplicative evaluation prior to referral to a radiologist.

In the Federal Register, CMS said that “the chiropractic exception is no longer warranted. We do not believe it would be necessary or appropriate to continue to permit payment for an x-ray ordered by a non-treating physician when a chiropractor, not the ordering physician, will use that x-ray.”