February 2002

HHS Prohibits Physical Therapists From
Providing Chiropractic Service Under Medicare

Washington, D.C. - The U.S. Department of Health and Human Services (HHS) has issued a new policy directive that, under Medicare, physical therapists cannot provide manual manipulation of the spine to correct a subluxation.

In a recent revision to an Operational Policy Letter originally issued in 1994, Medicare's Center for Beneficiary Choices writes: "The (Medicare) statute specifically references manual manipulation of the spine to correct a subluxation as a physician service. Thus, Medicare+Choice organizations must use physicians, which include chiropractors, to perform this service. They may not use non-physician physical therapists for manual manipulation of the spine to correct a subluxation."

A copy of the letter is available on the American Chiropractic Association's (ACA's) website at:
http://www.acatoday.com/images/jan15_2002_letter.jpg

"The ACA is extremely pleased that (HHS) Secretary Tommy Thompson and his department have formally recognized the unfairness and injustice to doctors of chiropractic and their patients that the 1994 Operational Policy Letter imposed," said ACA Chairman Dr. James Edwards. "We will continue the ACA's lawsuit to guarantee that no one other than doctors of chiropractic can deliver the chiropractic service since only the issue of illegal use of physical therapists has been resolved."

The ACA first filed its lawsuit against HHS's HCFA, now called the Centers for Medicare & Medicaid Services (CMS), in November 1998. The suit claimed that HHS guidelines unlawfully allow Medicare managed-care plans to substitute the services of other health-care providers for services that should legally be performed by doctors of chiropractic. Specifically challenged in ACA's lawsuit was the 1994 Operational Policy Letter.

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