NYSBC opinion regarding the use of physiotherapeutic modalities

I write regarding your inquiry about the use of physiotherapeutic modalities by chiropractors licensed in New York State. This letter is based on past opinions of the Education Department that have been issued in response to various inquiries from members of the public.

Adjunctive therapy modalities, sometimes referred to as "chiropractic physiotherapy," are addressed in Education Law, Section 6551(3), which states that "a license to practice chiropractic shall not permit the holder thereof to...utilize electrical devices except those devices approved by the board as being appropriate to the practice of chiropractic." Therapeutic devices directly or indirectly dependent upon electrical power that have been deemed appropriate to the practice of chiropractic include, but are not limited to: 1) electrical stimulation, 2) ultrasound, 3) traction, 4) diathermy, 5) hydrocollator or hot paks, 6) cryotherapy or cold paks, and 7) vibratory therapy.

Section 6505 of Education Law expressly allows for overlap among the professions, e.g., chiropractors may perform certain acts common to physical therapy so long as those acts are within the lawful practice definition of chiropractic. Furthermore, section 6732 does not protect the word "physiotherapy;" only the titles "physical therapist, physiotherapist or mechanotherapist" in connection with the provision of professional services.

Regarding specific devices, Part 73.3 of the Regulations of the Commissioner of Education provides that "pursuant to section 6551(3) of the Education Law, licensees may use any electrical devices essential to their practice provided such devices have not been disapproved by the Federal Food and Drug Administration or its successors, or by the department." A list of such devices disapproved by the FDA is maintained and periodically updated by the office of the State Board for Chiropractic. You may wish to contact the FDA office in your area to obtain the most recent listing.

Also please note that the Board of Regents Rules on Unprofessional Conduct holds that a practitioner may be in violation of Part 29.1(b)(9) if he or she is "performing professional responsibilities which the licensee knows or has reason to know that he or she is not competent to perform." It is clearly the responsibility of the licensee to acquire appropriate education and training in the use of any electrical devices before utilizing them in his or her professional practice. Special certification in the use of such devices is not required prior to their utilization in a professional practice, but certainly would provide evidence of competency in any event.

Utilization of any test or treatment modality is addressed in Regents Rules on Unprofessional Conduct, Part 29.2(a)(7), which defines as a violation the "ordering of excessive tests, treatment, or use of treatment facilities not warranted by the condition of the patient."

To avoid any deceptiveness in advertising professional services, it is recommended that any chiropractor offering physiotherapy modalities in his or her practice should refer to those services by using the modifier "chiropractic." In that way, the public will not be misled to believe that those services will be provided by someone other than a licensed chiropractor.

Finally, insurance coverage for any procedure performed by licensed professionals is not determined by Education Law. Although we may determine that a specific procedure is within the lawful scope of a given profession, that by itself does not constitute a requirement for reimbursing the cost of such a procedure under insurance benefit plans. Lawful scope of professional practice and insurance coverage are separate and distinct determinations made in accordance with Education Law and Insurance Law respectively.

Norman G. Cohen
Executive Secretary

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