The question of whether a chiropractor can order a Magnetic Resonance Imaging (MRI) scan for a patient enrolled in Medicare involves the intersection of two separate legal frameworks. The ultimate answer depends on a conflict between the state-level scope of practice, which dictates what a Doctor of Chiropractic (DC) is legally permitted to do, and the federal-level reimbursement rules set by Medicare. These federal rules determine what services the government insurance program will pay for. Understanding this regulatory divide is necessary for both the patient and the healthcare provider to navigate the process successfully.
Ordering Authority and State Licensure
A chiropractor’s legal authority to order diagnostic imaging, such as an MRI, is established solely by the laws and professional licensing boards within the specific state where they practice. This scope of practice varies significantly across the United States. In many states, the scope of practice for a Doctor of Chiropractic (DC) is broad enough to include the legal ability to order an MRI when clinically indicated for a patient’s neuromusculoskeletal condition.
In nearly every jurisdiction, DCs are legally permitted to order diagnostic procedures like CT scans and MRIs. Some states, like Arizona, explicitly state that ordering imaging studies is within the chiropractic scope of practice. This means that the act of writing the order itself is often a legal function of the chiropractor’s license, independent of any insurance considerations.
The variation between states means a DC in one region may have a more expansive legal ability to order advanced imaging than a DC in another. This state-level authority, however, only addresses the legal right to request the test, not the financial responsibility for it. The patient’s insurance coverage is the separate and more restrictive consideration.
Medicare Coverage for Diagnostic Tests
While chiropractors are recognized providers under Medicare Part B, the program’s coverage for services ordered by a DC is highly limited. Medicare Part B primarily covers the manual manipulation of the spine to correct a vertebral subluxation. This coverage does not extend to most other therapeutic or diagnostic services furnished by a chiropractor.
Medicare will not cover or pay for any diagnostic or therapeutic service that is ordered, performed, or interpreted solely by a chiropractor. This includes MRIs, X-rays, and other tests. The rule applies even if the state’s licensing board legally authorizes the DC to order the test, as Medicare will not reimburse for it.
To be eligible for Medicare reimbursement, advanced diagnostic imaging procedures like an MRI must be ordered and supervised by a Medicare-recognized physician, typically a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO). This federal requirement supersedes the state-level authorization granted to the chiropractor. If a Medicare patient receives an MRI based only on a chiropractor’s order, the patient will be responsible for the entire cost of the scan.
The Necessary Referral Process for Medicare Patients
Given Medicare’s strict reimbursement rules, the practical solution for a Medicare patient needing an MRI involves a formal referral process. The chiropractor, based on their clinical assessment, determines the necessity for advanced imaging to investigate the patient’s condition. This initial determination is the foundation of the referral.
The DC must formally refer the patient to a medical doctor, such as the patient’s primary care physician, a specialist, or an orthopedic surgeon. This physician, who is a fully recognized Medicare provider, must review the patient’s case and officially issue the order for the MRI. This step ensures that the imaging request complies with Medicare’s federal billing requirements.
The supervising physician is responsible for monitoring the test and interpreting the results, allowing the claim to be submitted to Medicare for reimbursement. This two-step process allows the chiropractor to utilize their clinical judgment. It also ensures the patient does not incur unexpected, non-covered expenses for the diagnostic test.