SB106 (Chiropractic Medicare Coverage Modernization Act of 2025) revises Medicare law to treat doctors of chiropractic as Medicare “physicians” for any function or service they are licensed to perform in the state where they work. The bill removes the long-standing statutory limitation that Medicare payment for chiropractic care applies only to manual spinal manipulation to correct a subluxation.
The bill also adds a payment condition: Medicare will pay for services furnished by chiropractors only if the practitioner has completed a single verification process—attending an educational documentation webinar or similar electronic product as designed by HHS—unless the service is the traditional spinal manipulation. That combination expands billing rights while creating new CMS implementation and compliance tasks that providers and payers will need to address.
At a Glance
What It Does
SB106 amends 42 U.S.C. 1395x(r)(5) to recognize doctors of chiropractic as physicians for any action they are licensed to perform and adds a new 42 U.S.C. 1395l(ee) limiting payment to chiropractors who have completed a Secretary‑designed verification webinar, except for manual spinal manipulation.
Who It Affects
Medicare Part B beneficiaries who use chiropractic services, doctors of chiropractic seeking Medicare reimbursement, CMS and its contractors (for verification and claims processing), and private practices that bill Medicare for musculoskeletal care.
Why It Matters
This bill would align Medicare coverage more with the VA, DoD, FEHB, and private insurers by broadening reimbursable chiropractic services, but it shifts policy questions about billing scope, coding, and program integrity to CMS and creates administrative compliance burdens for providers and the agency.
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What This Bill Actually Does
SB106 replaces the narrow, decades‑old Medicare definition that limited chiropractic reimbursement to a single service—manual manipulation of the spine to correct a subluxation—and instead recognizes a state‑licensed doctor of chiropractic as a Medicare “physician” for any function the practitioner’s state license authorizes. Practically, that means chiropractors could bill Medicare for a wider array of physician services they are allowed to perform under state law, rather than being restricted to a single procedure category.
The bill adds a separate payment condition: Medicare payment for services furnished by chiropractors will be allowed only if the chiropractor is verified once through a process the Secretary of Health and Human Services designs—described in the text as attending an educational documentation webinar or a similar electronic product—unless the service being billed is the traditional spinal manipulation for subluxation. That creates a binary path to payment: either the old spinal manipulation code remains payable as before, or the chiropractor must complete the CMS‑designed verification to bill for other services.Because the statute ties coverage to state licensure, the scope of what chiropractors can bill will vary state by state.
The bill does not alter Medicare payment rates, coding rules, or other program authorities; it simply broadens who may be treated as a physician under the statute and imposes a documentation‑training verification step as a condition of payment. The Secretary will need to translate these changes into operational guidance: define the verification process, map allowable services to billing codes, update provider enrollment and claims processing systems, and set enforcement and audit priorities.Finally, while the text cites alignment with other federal programs and private coverage practices, it leaves open important implementation questions: what specific physician services chiropractors may bill for in practice, how CMS will verify completion and guard against fraud, and how Medicare Advantage plans will integrate or respond to the expanded statutory recognition.
The Five Things You Need to Know
The bill amends 42 U.S.C. 1395x(r)(5) to recognize a state‑licensed doctor of chiropractic as a Medicare “physician” for any function or action the license authorizes in the state where performed.
The existing statutory limitation that Medicare covers only 'manual manipulation of the spine to correct a subluxation' is removed as the sole covered chiropractic service.
A new subsection, 42 U.S.C. 1395l(ee), conditions Medicare payment on a one‑time verification that the chiropractor has attended an HHS‑designed educational documentation webinar or similar electronic product, except when billing for spinal manipulation.
The webinar verification is a single, Secretary‑designed process; the bill does not specify content, frequency, delivery standard, or penalties for noncompliance beyond denying payment.
Coverage is explicitly constrained by state licensure: Medicare pays only for services the chiropractor’s state license legally authorizes, making allowable services state‑dependent.
Section-by-Section Breakdown
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Short title
Declares the bill’s name: 'Chiropractic Medicare Coverage Modernization Act of 2025.' This is purely nominative but signals policy intent to modernize Medicare chiropractic coverage.
Findings and purpose
Sets out Congress’s findings that the original 1972 statutory language is antiquated and contrasts Medicare coverage with VA, DoD, FEHB, and private plans. The purpose clause instructs that a doctor of chiropractic should be treated as a 'physician' for any licensable function—framing the statutory change as recognition rather than a new scope of practice, which matters for statutory interpretation and subsequent CMS rulemaking.
Expand 'physician' definition to include state‑licensed chiropractors
Strikes the existing narrow language and inserts wording that a doctor of chiropractic licensed by the State is a 'physician' for any function the license authorizes in that jurisdiction. Mechanically, this changes the statutory category that controls provider recognition under Medicare and allows chiropractors to bill for physician services they are permitted to perform under state law. Practically, CMS will need to decide which CPT/HCPCS codes chiropractors can use and how to align that with Medicare physician fee schedule rules.
Payment conditional on verification webinar or traditional manipulation
Adds a new payment limitation: Medicare will pay for services furnished by the chiropractors described in 1861(r)(5) only if the chiropractor either is verified once through a Secretary‑designed educational documentation webinar (or similar electronic product) or the service billed is manual spinal manipulation to correct a subluxation. This creates an administrative prerequisite for payment beyond provider enrollment, but leaves the webinar’s content, timing, and enforcement to HHS.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Medicare beneficiaries who seek broader musculoskeletal care: They may gain access to a wider range of chiropractor‑provided services under Medicare where state law permits, reducing barriers for non‑spinal manipulative treatments currently not payable.
- Doctors of chiropractic: Expanded ability to bill Medicare for services within their state scope of practice could increase revenue streams and formal recognition as Medicare 'physicians' for billable services.
- Federal health programs and insurers following precedent: Alignment with VA, DoD, and FEHB practices may simplify interprogram comparisons and support continuity of covered services across federal systems.
Who Bears the Cost
- Centers for Medicare & Medicaid Services: CMS must design and operate the verification mechanism, update claims systems, create coding guidance, and conduct oversight—work that requires administrative resources.
- Medicare program (trust funds): Broader coverage will likely increase utilization and spending for chiropractor‑provided services, at least initially, absent offsetting payment changes.
- Chiropractic practices: Providers must complete the Secretary‑designed webinar verification and adapt billing and documentation workflows, and they may face new audit exposure as CMS defines allowable services and monitors compliance.
Key Issues
The Core Tension
The bill balances two legitimate goals—expanding access to chiropractor‑provided care and modernizing provider recognition—against program integrity and fiscal risk: broadening who may bill Medicare can improve access and align benefits with other federal programs, but it also amplifies CMS’s administrative and oversight burden and creates a risk of increased spending and inconsistent nationwide application because coverage is tethered to variable state licensure.
The statute expands who is a Medicare 'physician' for chiropractic services but leaves critical operational details to HHS. The bill does not define which physician services chiropractors may bill in specific coded terms; it instead ties permissibility to state licensure.
That makes allowable Medicare claims a moving target across states and places the burden on CMS to map state scopes of practice into a national claims processing framework. Absent clear coding guidance, claims adjudication, prior authorization, and audit activity could spike as contractors interpret allowable services.
The webinar verification requirement is another implementation hinge: the bill makes payment contingent on a single, Secretary‑designed educational product but provides no content standard, quality metric, or penalty scheme beyond payment denial. That invites questions about whether the verification is substantive training, a documentation checklist, or a narrow compliance step.
If HHS sets a low bar, program integrity risks could rise; if it sets a high bar, access gains could be blunted by administrative friction for providers and beneficiaries. Finally, the bill broadens statutory recognition without addressing related Medicare rules—physician supervision, incident-to billing, scope for incident payment rates, and integration with Medicare Advantage—so jurisdictional and payment conflicts are likely during implementation.
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