In a recent ruling by CMS, it has been proposed to cut Medicare rates for chiropractic care by 2% in 2010.  Chiropractic was involved in a Medicare demonstration project to examine the cost-effectiveness of chiropractic care in comparison to medical and physical therapy services. 

Although the results of the demonstration have not been reported at this time, the following is an excerpt of a proposed ruling by CMS. 

Is this a glimpse into the Medicare demonstration project results due to be released later this year?  The comment period closed August 31, 2009.

The July 13, 2009, CMS Federal Register publication of: Medicare Program; Payment Policies Under the Physician Fee Schedule, and Other Revisions to Part B for CY2010; Proposed Rule, is provided for additional information and detail.

Discussion of Chiropractic Services Demonstration
The MMA requires the Secretary to evaluate the feasibility and advisability of expanding coverage for chiropractic services under Medicare.  Under Medicare, coverage for chiropractic services is limited to manual manipulation of the spine to correct a subluxation.  The Demonstrations expanded current coverage to include “care for neuromusculoskeletal conditions typical among eligible beneficiaries and diagnostic and other services that a chiropractor is legally authorized to perform by the State of jurisdiction in which such treatment is provided.”  The 2-year demonstration was conducted in 4 geographically diverse sites; 2 rural and 2 urban.  The demonstration ended 3/31/07.  The PFS for 2006, 2007 and 2008 discussed the BN [Budget Neutral] requirement and how chiropractor fees would be adjusted should the demonstration result in costs higher than those that would occur in the absence of the demonstration. If the demonstration was not BN it was anticipated to make the necessary adjustments during 2010 and 2011.

Two approaches in examining the BN were used; the All Neuromusculoskeletal Analysis (NMS) and the Chiropractic User Analysis.  The results of both analyses were not budget neutral.  The total effect of the demonstration to Medicare was $50 million.  Because the costs of the demonstration were higher than expected, it is proposed to recoup the $50 million in expenditures over a 5 year period.

Therefore, it is proposed to reduce the payment amount under the PFS for CPT 98940-98942 by 2%.