Chiropractors are the only healthcare providers that CANNOT opt-out of Medicare. When you see seniors with Medicare in your practice you must do Medicare correctly!
Each Medicare carrier provides a fee schedule for the Chiropractors each year in each state local. You can go to your Medicare Carrier's website search for Physician Fee Schedule (go to about page 245) and you will find 98940, 98941 and 98942 with specific fees for your local for both participating and non-participating providers. The code with the # sign indicates the fees set for if you adjust this patient in another facility other than your office. The fees without the # sign are your in-office fees.
Participating providers may bill the Medicare Carrier whatever fee they wish. The Medicare Carrier has the responsibility to know your Medicare fees and will automatically reimburse to the DC 80% of those fees. The Chiropractor must collect the 20% from the patient or supplemental insurance and NEVER collect from any payor above the set fees by the Medicare Carrier. If you do, and get caught, the fines are up to $10,000.00 per incident.
A non-participating provider must know what the Medicare fees are prior to seeing or billing either the Medicare patient or the Medicare Carrier. If they don’t and get caught, they may be fined up to $10,000.00 per incident and the same for being paid above the set Medicare fees. The non-participating provider must never collect or bill any payor above the "limiting" charge, including a Medicare patient in auto accidents, worker’s comp., etc.