ACA Insurance Relations: Important Decision Regarding Mechanical Traction

A recent decision by the US District Court of the District of Rhode Island may have significant implications for doctors of chiropractic (DCs) across the country who bill for mechanical traction. In 2009, Blue Cross Blue Shield Rhode Island (BCBS RI) sued two providers in state court for allegedly fraudulently billing intersegmental traction as mechanical traction, CPT code 97012. Attorneys for the providers were able to successfully move the case to federal court where the judge in the case, Senior Judge Ronald R. Lagueux, found that the fraud claims were "completely preempted" by the Employee Retirement Income Security Act (ERISA). At the conclusion of the resulting bench trial, Judge Lagueux found that the services were correctly billed by the providers as mechanical traction and rejected BCBS RI's findings of fraudulent billing, stating that the plaintiffs "did no wrong." The case was argued on behalf of the plaintiffs by D. Brian Hufford of Pomerantz, Grossman, Hufford, Dahlstrom & Gross, LLP (Pomerantz), the same firm representing ACA and other plaintiffs in class action suits against United Healthcare/Optum and Cigna and ASHN.

While this lawsuit was not the result of any action by ACA, it has been ACA's policy for over a decade that "Roller table type traction normally meets the requirement of autotraction, the use of the body's own weight to create the force" and therefore is properly coded, as the doctors in question had and the court supported, with 97012. While doctors of chiropractic should always verify coverage to determine each payer's specific reimbursement policy, this decision may have an impact on providers who have had reimbursement for traction recouped (Note: This decision references only intersegmental or roller table type traction, not non-surgical spinal decompression). DCs who have experienced this type of recoupment by any payer are encouraged to contact Mr. Hufford directly at:

D. Brian Hufford
Pomerantz Grossman Hufford
   Dahlstrom & Gross LLP
600 Third Avenue
New York, NY 10016
212.661.1100
614.610.1406 (fax)
[email protected]