According to Medicare, chiropractic services are performed through the means of manual manipulation (i.e., by use of the hands) of the spine.
Chiropractic (therapeutic) manipulation, commonly referred to as spinal and extraspinal adjustment, manual adjustment, vertebral adjustment, or spinal manipulative therapy (SMT), is the treatment of the articulations of the spine and musculoskeletal structures, including the extremities, for the purpose of relieving discomfort resulting from impingement of associated nerves or other structures (e.g., joints, tissues, muscles). In spinal manipulation, manual or mechanical means may be used to correct a structural imbalance or subluxation related to distortion or misalignment of the vertebral column.
Subluxation is an alteration in alignment, movement integrity, and/or physiologic function of the spine in which contact between the surfaces of the joints remains intact. Subluxation may be acute or chronic. Acute subluxation is defined as a new injury, identified by X-ray or physical exam, in which the result of chiropractic manipulation is expected to be an improvement in, or arrest of progression, of the individual's condition. Chronic subluxation is defined as an existing injury that is not expected to significantly improve or be resolved with further treatment but where the continued therapy can be expected to result in some functional improvement. Once the clinical status has remained stable for a given condition, without expectation of additional objective clinical improvements, ongoing manipulation is considered maintenance therapy.
Extraspinal manipulation, also known as extraspinal manipulative therapy (EMT), is used to treat joint dysfunction outside of the vertebral column. Extraspinal regions are the following: head (excluding atlanto-occipital, including temporomandibular joint), lower extremities, upper extremities, rib cage (excluding costotransverse and costovertebral joints), and abdomen.
Maintenance therapy is defined as a treatment plan that seeks to prevent disease, promote health, and prolong and enhance the quality of life, or as a therapy that is performed to maintain or prevent deterioration of a chronic condition. When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the chiropractic treatment becomes supportive rather than corrective in nature, the treatment is then considered maintenance therapy.