In August 2020, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2021. The declared intent of this rule is to improve reimbursement of E/M services and expand coverage of Telehealth and other services including Opioid Use Disorder Treatment.  To offset the budgetary impact of these increases, which HHS is required to do, the rule implements significant proposed reductions for other services.  Increases and reductions are accomplished by reassigning RVUs for certain services.  Unfortunately, payments to chiropractic physicians and other providers will be significantly reduced.

Medicare uses a system of “relative value units” (RVUs) to arrive at its fee schedule.  RVUs are applied to each service for physician work, practice expense, and malpractice.  These RVUs become payment rates through the application of a conversion factor. Each CPT code is given a value, expressed as a number of “RVUs,” that is then multiplied by a “conversion factor” to calculate the fee.  In short, Medicare is cutting the relative value units (RVUs) for 9894x codes by 10% (7% physician work and 3% practice expense). Additionally, they are cutting the conversion factor by over 10%. The result is a Medicare allowable amount cut of 19.54% for chiropractic adjustments. Of course, spinal adjustment – CPT codes 9894x – is the only service for which Medicare pays chiropractic physicians, and these changes are unacceptable.

The Tennessee Chiropractic Association is strenuously opposed to these changes.  As Medicare is a standard referenced by numerous other insurers, including the TN Workers’ Compensation System, the impact that that these reductions will have on the chiropractic profession and the Medicare patients that we serve are ill-advised, inconsistent with the rule’s purpose, and will have far reaching effects.

Therefore, we are taking action on your behalf and encouraging you to do the same.


  1. The TCA filed official comments to HHS and CMS regarding the rule.  This is an important step in our formal advocacy efforts to ensure that CMS is fully aware of the negative impact of these changes.  To view the TCA’s View the TCA’s Letter here.
  2. We are asking all DCs in Tennessee to reach out to your Congresspersons, urging them to take action prior to Oct. 5th to prevent the rule from becoming finalized.  Many experts believe that Congress will have to take action in order to stop these changes from occurring.  TN DCs CLICK HERE to take 5-minutes to contact your congressperson today!! 
  3. TCA is also working with ChiroCongress and many other state associations to increase the strength of our voices, and the impact we can have by working in larger numbers to communicate with CMS and Congressional leaders on this very important issue.