I get this question very frequently.  And according to the Medicare 2008 billing guide below (sections 40 thru 40.4), the answer is a resounding Yes.  According to Medicare all physicians who have not opted out of Medicare have to bill for covered services provided to a Medicare patient, on the behalf of the patient.  It also says that Chiropractors are not qualified as physicians who can opt out of Medicare.  So, yes, you have to bill for covered services.  Now let's define covered services.  Covered services are defined as those services listed in your Medicare LCD, or Medicare Chiropractic Billing Guide, as being covered by Medicare and are medically necessary.  In the Chiropractic case this is 98940, 98941 and 98942, for the time being.  Any codes outside these, that are listed, are excluded from being covered when provided by a Chiropractor, ie. exams, x-rays, extraspinal adjustments and other therapies.  Adjustments must also be medically necessary.  Pain is expected by Medicare to be alleviated in about 12 visits or so, depending on the patient and the diagnosis related to the pain.  When the pain is gone, then there is no longer medical necessity and you are then treating your patients for maintenance care which is not covered, ever, by Medicare.  You do not have to bill for services that you know are not covered by Medicare, but you do have to let the patient know what services will not be covered by Medicare and why, before the patient receives these services, so that the patient has an opportunity to opt out of the care.  This is called the Advance Beneficiary Notice.  Learn how to use these and when to use them.  Chiropractors, not enrolling in Medicare does not exempt you from billing Medicare.  If you are not enrolled in Medicare and you are providing covered services to Medicare patients, you are committing fraud, cheating your patients and putting yourself in a very bad position.  Read below for specifics.  If you have any other questions regarding Medicare billing call  888-570-3042

Leslie Barlow, CMC, CMRS

http://www.cms.hhs.gov/manuals/downloads/bp102c15.pdf