X-Rays

Subluxation may be demonstrated by an X-ray or physical examination.

An X-ray is not covered if it is taken or ordered by a chiropractor. Neither the participating physician group (PPG) nor Health Net can refuse to authorize coverage of an X-ray taken solely to diagnose subluxation in order to support the need for chiropractic care as long as the X-ray is ordered, taken and interpreted by a doctor of medicine or osteopathy. Generally, Medicare Advantage (MA) members seeking chiropractic services have clinical indications that would support medical necessity for an X-ray or physical examination. If those indications are present, Maximus Federal Services (the Centers for Medicare and Medicaid Services' independent review entity) would likely overturn any denial.

If the member has an X-ray from any source that fulfills the coverage criteria, the member is entitled to a referral.

If an member is requesting an X-ray for what appears to be routine chiropractic care (non-Medicare covered), the member's primary care physician (PCP) should inform the member that these services are not covered under Original Medicare and that the member is financially responsible.