The chiropractor is afforded the opportunity to effect improvement or arrest or retard
deterioration in such condition within a reasonable and generally predictable period
of time. Acute subluxation problems may require as much as 3 months of treatment but
some require very little treatment. In the first several days treatment may be quite
frequent but decreasing in frequency with time or as improvement is obtained.
Chronic spinal joint condition implies, of course, the condition has existed for a
longer period of time and that, in all probability, the involved joints have already
“set” and fibrotic tissue has developed. This condition may require a longer treatment
time, but not with higher frequency.
Carriers develop parameters under which an extension in the course of treatment could
be supported based on special documentation of need and under which coverage will
be finally terminated for lack of reasonable expectation that continuation of treatment
could be beneficial.
Some chiropractors use an “intensive care” concept of treatment. Under this approach multiple daily visits (as many as four
or five in a single day) are given in the office of clinic and so-called room or ward
fees are charged since the patient is confined to bed usually for the day. The room
or ward fees are not covered and reimbursement under Medicare is limited to not more
than one treatment per day unless documentation of the reasonableness and necessity
for additional treatment is submitted with the claim.