Medicare at Back in Line

As of August 1, 2024, all providers in our office are Non-Participating Providers with Medicare. Medicare does NOT allow Chiropractors to Opt-Out of caring for Medicare patients. Medicare has various rules and guidelines for treatment and care of Medicare patients. We prefer to treat our Medicare patients with a multi-faceted approach. Unfortunately, Medicare ONLY wants chiropractors to treat musculoskeletal pain as it pertains to the neck, mid back, and lower back. We refuse to have a limited scope of what we feel most Medicare patients (benefactors) actually deserve ...

  • Medicare Coverage for Chiropractic Services: Medicare allows for 12 chiropractic adjustments of the spine per year or per episode of a major complaint (e.g., low back injury, neck pain, or radiating arm pain). Medicare only covers chiropractic adjustments of the spine, which includes the neck, mid-back, low back, and pelvic region. Care for Medicare to cover, must be musculoskeletal in nature in order to be considered, "medically necessary" and for coverage to exist. Medicare does NOT reimburse providers for EXAM fees, or X-rays when indiciated. Those fees are passed onto the patient. A new patient exam, and/or a Re-Exam (if a new injury occurs, or it's been greater then 3 months since your last visit, or you've had a change in your health history since you were last seen) are all reasons WHY an exam and health history reivew MUST be documented, and per Medicare rules, you MUST be billed. Not billing for services provided to a Medicare patient is considered an INDUCMENT and is Federal Offense and punishable if a provider/office is found to be offering "write-offs" and not billing/charging Medicare patients for services rendered. You may read more about it here. Special Advisory Bulletin: Offering Gifts and Other Inducements to Beneficiaries (hhs.gov)
  • Exclusions from Medicare Coverage: Medicare does not cover treatment for extremity issues such as shoulder pain, hip pain, knee pain, foot pain, plantar fasciitis, rotator cuff injuries, IT band syndrome, piriformis syndrome, and similar conditions. Additionally, Medicare does not pay chiropractors for exam fees, and documentation time for care outside of the chiropractic adjustment. These are non-covered and not reimbursed to the providers. Instead, the provider has to bill the patient for care and time outside of the chiropractic adjustment. Medicare also does not cover maintenance care (being seen every 2-3 weeks, or 1x/month just to stay feeling good). We are instructed to have a care plan in place and once a care plan has ended, the patient is not to be rescheduled for follow up visits and they may be deemed as wellness/maintenance care, and Medicare does not reimburse for those visits. The patient will have to call IF they develop neck pain or back pain again. However, many patients have chronic low back pain, or hip pain, and respond better under routine care. This unfortunately is not covered by medicare guidelines. 
  • Imaging Services and Diagnostics: Medicare will not reimburse for any imaging services (e.g., X-rays, MRIs) or labs ordered by a chiropractor, even if performed at a medical and in-network facility.
  • Complex Care Needs: Many Medicare patients may have age-related or advanced osteoarthritis, recent trauma, or other comorbidities that complicate care. Medicare’s restrictions can make it challenging to provide the quality of care we strive to offer, and in our opinion, deliver the care we believe Medicare patients deserve. 
  • Additional paperwork: Medicare requires due diligence of healthcare providers to prove we are not taking advantage of our patients and overselling and recommending services and procedures that are financially burdensome to our patients. This requires a high degree of documentation and extra time dedicated to paperwork. 

Given these constraints, we have found it increasingly difficult to offer the level of care we believe is necessary under Medicare’s guidelines. Moreover, the complexity of co-managing Medicare patients with other healthcare providers, particularly given the common presence of comorbidities such as cardiovascular issues, insulin resistance, diabetes, and medication interactions, has contributed to our decision.

Our traditionally medical professionals with in the Corridor are some of the hardest working and most sincere individuals who care deeply for their patients. However, the constraints imposed by Medicare to us as Chiropractors, along with the challenges in obtaining timely primary care appointments with your In-Network MD, DO, DRNP, APRN, PA-C is burdensome for many Medicare patients. We apologize for the inconvience to your access in receiving quality care for our Medicare patients. 

If you elect to seek care at Back in Line, and you are a Medicare Patient, you can expect the following pricing for office visits:

  • Chiropractic Adjustment: $42.50 (Medicare may reimburse you to $37.77. This is vary depending on if you typically have a co-payment, or co-insurance)  
  • Soft tissue with an adjustment: $35 additional fee/region (hip, shoulder, back)
  • Soft tissue only, no adjustment: $70, up to 2 regions (neck & shoulder, or back & hip)  
  • Exams and Re-Exams: Fees range from $50-$150. These charges are based on time, and complexity of condition. Patients may have questions about their diagnosis, or wish to discuss care and treatment options for their chronic hip pain, bursitis, or plantar fascia pain, etc. If it has been greater then 3 months since your last office visit, OR if you have a new injury OR change in your health history (heart attack, new diagnosis, change of medications, etc), you can expect re-exam free that can range from $50-$150 depending on the complexity of changes.
  • Consultations: Fees range from $50-$450, based on time and complexity. Patients may have questions about their recent labs or seek functional medicine consultations. These are never covered by insurance based on "medical necessity parameters" established by Medicare, and most insurance comapnies. 

It is our office's professional opinion that most Medicare Patients benefit from the chiropractic adjustment, as well as additional care to supporting structures of the muscles, ligaments, and tendons. We observe those patients feel better quicker, and stay better longer in between office visits. We also believe in reasonable maintenance care of 1-2 treatments/month in many cases.

If patients desire more time with the provider, and additional treatments, they can schedule with Drs. Weber, and Kleene, with average office visit charges being $77.50/office visit. (this is a 10 min apt). Currently, Dr. Wessels is electing to not accept Medicare patients and refers to other providers. 

We still have to submit claims to medicare. You may get reimbursed by Medicare, but it will be based on if Medicare deems your claims as medically necessary for the Chiropractic Adjustment. You will not be reimbursed by Medicare, or secondary policies, for ANY OTHER services offered at our office per Medicare Guidelines.

If you would like to have your labs reviewed, or if you would like to consider utilizing Functional Medicine and Health Consultation, appointments are based on the time spent during the encounter with Dr. Kleene reviewing your health history, reviewing your previous or recent labs, discussing your goals, and developing a plan to optimize your health and quality of life. 

As a Non-Participating provider, Dr. Kleene is able to better serve her patients overall health and wellness and offer Functional Medicine consults to her Medicare patients. You may email frontdesk@mybackinlie.com if you would like a consultation, or give the front desk a call at 319-892-3363.