Over the past several years, chiropractors and physical therapists have
argued over which profession has the ability – and authority – to
perform adjustments and/or manual manipulation of the spine to correct
vertebral subluxations.
Recently, the U.S. Department of Health and Human Services Centers for
Medicare & Medicaid Services (CMS) issued a policy letter that helps
put the question to rest.
In clarifying its position on which practitioners are authorized by law
"to perform manual manipulation of the spine to correct a subluxation
as a Medicare-covered service," the CMS referred to Section 1861(r)
of the Social Security Act. The Department noted, "The 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 press release issued by the American Physical Therapy Association
indicated that the organization is "currently in communication with
CMS in an attempt to determine the meaning of the statements contained in
the policy letter and the Agency’s purpose and intent in publishing the
letter."
To chiropractors, the meaning of the statements is clear. Correcting
vertebral subluxation cannot be done by physical therapists.
"Correcting vertebral subluxation is an exact art and science, which
can only be performed by a trained and licensed doctor of
chiropractic," stated World Chiropractic Alliance President Terry A.
Rondberg, D.C. "While physical therapists play a vital role in the
American health care system, they do not – and cannot – duplicate the
services of doctors of chiropractic."
