American Physical Therapy Association (APTA)
President Ben F Massey, Jr, PT
February 7, 2002

RE: CMS Operational Policy Letter Regarding 
Medicare+Choice Coverage for Physical Therapists 
Performing Manual Manipulation of the Spine to Correct a 
Subluxation

APTA recently learned that the Centers for Medicare & Medicaid 
Services (CMS) issued an Operational Policy Letter addressing the 
question of "which practitioners are authorized by law to perform 
manual manipulation of the spine to correct a subluxation as a 
Medicare-covered service." The CMS letter concludes that 
Medicare+Choice organizations "may not use non-physician physical 
therapists for manual manipulation of the spine to correct a 
subluxation." The CMS letter reasons that, because the Medicare law 
refers to manual manipulation of the spine to correct a subluxation 
only in a section that defines a "physician" for purposes of the 
statute, manual manipulation of the spine to correct a subluxation is 
"a physician service," and thus Medicare+Choice organizations may 
only use physicians (and not physical therapists) to provide the 
service.
APTA is currently in communication with CMS in an attempt to 
determine the meaning of the statements contained in the policy 
letter and the Agency¼s purpose and intent in publishing the letter. It 
is important to note that the letter relates only to manual 
manipulation of the spine to correct a subluxation. Physical 
therapists have long been recognized as being authorized to provide 
manual manipulation of the spine as a Medicare-covered service and 
to bill for these services under specific 97000 series codes. There 
is no indication in the recent Policy Letter that it is intended in any 
way to affect that recognition and coverage.
Approximately one year ago, in the interest of protecting the rights 
of physical therapists to continue to provide manual manipulation of 
the spine as a covered Medicare service, APTA moved to intervene in 
a lawsuit brought by the American Chiropractic Association (ACA) 
against the Secretary of Health and Human Services. Among other 
claims in that lawsuit, the ACA has challenged the government¼s 
recognition of physical therapists as providers of manual 
manipulation of the spine under the Medicare+Choice program. APTA 
has argued vigorously in its motions that the Medicare statute is not 
properly interpreted as providing that chiropractors are the only 
practitioners authorized to provide manual manipulation of the spine 
to correct a subluxation. The Association is still awaiting the 
court¼s decision on its petition to intervene and is reviewing the 
new Policy Letter to determine whether further action may be 
required in the lawsuit.
APTA is committed to ensuring that our members¼ rights to provide 
manual manipulation of the spine as a Medicare-covered service will 
not be compromised. We will continue to work closely with CMS to 
make sure that physical therapists, who have long been authorized to 
perform this Medicare-covered service, will retain that right. 
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