Table 1.

Key issues for expanded coverage for chiropractic services under Medicare

	Issues	Challenges	Recommendations
Claims documentation	OIG reports inadequate documentation of chiropractic claims.19,52	DCs must correct deficiencies. Medicare requires documentation of chiropractic evaluation and services but does not reimburse for same.	State and national chiropractic organizations should continue and strengthen efforts to improve claims and documentation practices.
Maintenance care	Medicare considers “maintenance care” to be an unnecessary service.53 Small clinical trials support the effectiveness of “maintenance care,”35,36,40,54 but more evidence is needed.	To conduct the research required to demonstrate any benefits of “maintenance care”	Conduct rigorous efficacy/effectiveness studies.
Uncertain consequences of increased coverage on costs	A demonstration project projected increased costs from expansion of coverage.17	Methodological concerns about the demonstration Lack of cost-effectiveness data	Conduct needed clinical studies, targeted at the triple aim of high-quality care, affordability, and improved health.

DC, doctor of chiropractic; OIG, Office of the Inspector General.