Details of CMS Demonstration Project Revealed

In December 2004 and January 2005, Dynamic Chiropractic reported on a new chiropractic demonstration project established with the passage of the Medicare Prescription Drug, Improvement and Modernization Act.^1,2 The objective of the project, scheduled to begin in April 2005, is to determine whether coverage of chiropractic services should be expanded to include additional forms of care not currently covered under supplementary Medicare insurance, also known as Medicare Part B.

The original project called for chiropractic services to be delivered at four test sites - two in rural areas and two in urban areas, with one site from each category in a "health professional shortage area." Initial project areas included eight counties that comprised the metropolitan area of Chicago, Illinois; 17 counties in central Virginia; and the entire states of Maine and New Mexico. The project was later expanded to include a total of 26 counties in Illinois and a county in eastern Iowa, bringing the total number of states in the demonstration project to five and allowing hundreds of thousands of Medicare recipients to experience the benefits of chiropractic care firsthand.

Since reporting on those developments, DC has learned that the formal details of the demonstration project have been officially published, as a notice in the Jan. 28, 2005 issue of the Federal Register.³ The notice includes a variety of guidelines and provisions for practitioners, along with background information on the selection of sites and contact information.

Services Covered Under the Demonstration Project

The Federal Register notice details five guidelines regarding the types of chiropractic services that can be delivered as part of the demonstration:

1. Services must be related to active treatment of a neuromusculoskeletal disorder, not maintenance or prevention. All claims under the demonstration are required to have the active therapy modifier.
2. The demonstration will expand the services chiropractors are allowed to provide, but only for the treatment of neuromusculoskeletal conditions. Among the services chiropractors can provide are plain X-rays, electromyography tests, nerve conduction studies, magnetic resonance imaging (MRI) scans, and computed tomography scans. Chiropractors can also order or provide laboratory tests, provided they are legally allowed to do so in the state in which they practice.
3. The demonstration will cover Current Procedural Terminology (CPT) code 98943 for extraspinal manipulation, which is a recognized procedure for the treatment of musculoskeletal conditions. The project will also expand coverage to include other services chiropractors are legally allowed to provide and that Medicare currently covers, including electrotherapy, ultrasound, transcutaneous electrical nerve stimulation therapy, and other "medically necessary" services for the treatment of musculoskeletal conditions.
4. DCs delivering the above services will be subject to the same payment policies as other Medicare clinicians who deliver these services. Chiropractors would also be reimbursed for evaluation and management (E&M) services delivered for neuromusculoskeletal conditions. Under the project's guidelines, chiropractors would be allowed to bill Medicare for treatment in addition to an E&M visit on the same day, the first time they assess a patient, and thereafter only when assessing a patient for a new, separate problem not currently being treated.
5. Chiropractors are required to submit claims for demonstration services separately from claims for currently covered services, and will have to add a demonstration code to all demonstration claims in order to receive reimbursement.

Since the demonstration project is required to be "budget neutral," the benefits of chiropractic care can be offered under both Medicare Advantage plans as well as Medicare fee-for-service beneficiaries. However, Medicare Advantage plans are not required to participate in the project.

To read the official notice of the chiropractic demonstration project in the Federal Register, visit www.amerchiro.org/pdf/FROnDemo.pdf. Written inquiries about the project should be submitted to:

Centers for Medicare & Medicaid Services
ATTN: Sidney Trieger
Division of Health Promotion and Disease Prevention Demonstrations
Office of Research, Development, and Information
Centers for Medicare & Medicaid Services
S3-02-01
7500 Security Boulevard
Baltimore, MD 21244-1850

Interested parties can also call (410) 786-3039 or (410) 786-6613, or e-mail MMA_section_651@cms.hhs.gov.

References

1. Devitt M. CMS announces four-state chiropractic demonstration project. Dynamic Chiropractic, Dec. 16, 2004. www.chiroweb.com/archives/22/26/04.html.
2. New chiropractic demonstration project gets an adjustment: one state, 19 counties added to list of test sites. Dynamic Chiropractic, Jan. 15, 2005. www.chiroweb.com/archives/23/02/14.html.
3. Department of Health and Human Services. Centers for Medicare & Medicaid Services. CMS-5037-N. Medicare Program: Demonstration of Coverage of Chiropractic Services Under Medicare. Agency: Centers for Medicare & Medicaid Services (CMS), HHS. Action: Notice. Federal Register, Jan. 28, 2005, p. 4130.