(a) Definitions. The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise:      
        (1) Board--The Texas Board of Chiropractic Examiners.       
        (2) CPT Codebook--The American Medical Association's annual Current Procedural Terminology Codebook (2004). The CPT Codebook has been adopted by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services as Level I of the common procedure coding system.       
        (3) Cosmetic treatment--A treatment that is primarily intended by the licensee to address the outward appearance of a patient.       
        (4) Incision--A cut or a   surgical wound; also, a division of the soft parts made with a knife or hot laser.       
        (5) Musculoskeletal system--The system of muscles and tendons and ligaments and bones and joints and associated tissues and nerves that move the body and maintain its form.       
        (6) On-site--The presence of a licensed chiropractor in the clinic, but not necessarily in the room, while a patient is undergoing an examination or treatment procedure or service.       
        (7) Practice of chiropractic--The description and terms set forth under Texas Occupations Code §201.002, relating to the practice of chiropractic.       
        (8) Subluxation--A lesion or dysfunction in a joint or motion segment in which alignment,   movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity.       
        (9) Subluxation complex--A neuromusculoskeletal condition that involves an aberrant relationship between two adjacent articular structures that may have functional or pathological sequelae, causing an alteration in the biomechanical and/or neuro-physiological reflections of these articular structures, their proximal structures, and/or other body systems that may be directly or indirectly affected by them.       
      (b) Aspects of Practice.      
        (1) A person practices chiropractic if they:                  (A) use objective or subjective means to analyze, examine, or evaluate the biomechanical condition of the spine and musculoskeletal system of the human body; or                   (B) perform nonsurgical, nonincisive procedures, including adjustment and manipulation, to improve the subluxation complex or the biomechanics of the musculoskeletal system.         
        (2) Needles may be used in the practice of chiropractic under standards set forth by the Board but may not be used for procedures that are incisive or surgical.       
        (3) This section does not apply to:                  (A) a health care professional licensed under another statute of this state and acting within the scope of their license; or                   (B) any other activity not regulated by state or federal law.         
      (c) Examination and Evaluation.      
        (1) In the practice of Chiropractic, licensees of this board provide necessary examination and evaluation services to:                  (A) Determine the bio-mechanical condition of the spine and musculoskeletal system of the human body including, but not limited to, the following:                      (i) the health and integrity of the structures of the system;                       (ii) the coordination, balance, efficiency, strength, conditioning and functional health and integrity of the system;                       (iii) the existence of the structural pathology, functional pathology or other abnormality  of the  system;                       (iv) the nature, severity, complicating factors and effects of said structural pathology, functional pathology or other abnormality of the system;                       (v) the etiology of said structural pathology, functional pathology or other abnormality of the system; and                       (vi) the effect of said structural pathology, functional pathology or other abnormality of the system on the health of an individual patient or population of patients;                     (B) Determine the existence of subluxation complexes of the spine and musculoskeletal system of the human body and to evaluate their condition including, but not limited to:                      (i) The nature, severity, complicating  factors and  effects of said subluxation complexes;                       (ii) the etiology of said subluxation complexes; and                       (iii) The effect of said subluxation complexes on the health of an individual patient or population of patients;                     (C) Determine the treatment procedures that are indicated in the therapeutic care of a patient or condition;                   (D) Determine the treatment procedures that are contra-indicated in the therapeutic care of a patient or condition; and                   (E) Differentiate a patient or condition for which chiropractic treatment is appropriate from a patient or condition that is in need of care from a medical or other class of provider.         
        (2) To evaluate and examine individual patients or patient populations, licensees of this board are authorized to use:                  (A) physical examinations;                   (B) diagnostic imaging;                   (C) laboratory examination;                   (D) electro-diagnostic testing, other than an incisive procedure;                   (E) sonography; and                   (F) other forms of testing and measurement.         
        (3) Examination and evaluation services which require a license holder to obtain additional training or certification, in addition to the requirements of a basic chiropractic license, include:                  (A) Performance of radiologic procedures, which are  authorized  under the Texas Chiropractic Act, Texas Occupations Code, Chapter 201, may be delegated to an assistant who meets the training requirements set forth under §74.2 of this title (relating to Registration of Chiropractic Radiologic Technologists).                   (B) Technological Instrumented Vestibular-Ocular-Nystagmus Testing may be performed by a licensee with a diplomate in chiropractic neurology and that has successfully completed 150 hours of clinical and didactic training in the technical and professional components of the procedures as part of coursework in vestibular rehabilitation including the successful completion of a written and performance examination for vestibular specialty or certification. The professional component of these procedures may  not be  delegated to a technician and must be directly performed by a qualified licensee.         
      (d) Analysis, Diagnosis, and Other Opinions.      
        (1) In the practice of chiropractic, licensees may render an analysis, diagnosis, or other opinion regarding the findings of examinations and evaluations. Such opinions could include, but are not limited to, the following:                  (A) An analysis, diagnosis or other opinion regarding the biomechanical condition of the spine or musculoskeletal system including, but not limited to, the following:                      (i) the health and integrity of the structures of the system;                       (ii) the coordination, balance, efficiency, strength, conditioning and functional  health  and integrity of the system;                       (iii) the existence of structural pathology, functional pathology or other abnormality of the system;                       (iv) the nature, severity, complicating factors and effects of said structural pathology, functional pathology, or other abnormality of the system;                       (v) the etiology of said structural pathology, functional pathology or other abnormality of the system; and                       (vi) the effect of said structural pathology, functional pathology or other abnormality of the system on the health of an individual patient or population of patients;                     (B) An analysis, diagnosis or other opinion regarding a subluxation complex of the  spine or  musculoskeletal system including, but not limited to, the following:                      (i) the nature, severity, complicating factors and effects of said subluxation complex;                       (ii) the etiology of said subluxation complex; and                       (iii) the effect of said subluxation complex on the health of an individual patient or population of patients;                     (C) An opinion regarding the treatment procedures that are indicated in the therapeutic care of a patient or condition;                   (D) An opinion regarding the likelihood of recovery of a patient or condition under an indicated course of treatment;                   (E) An opinion regarding the risks associated with the treatment  procedures  that are indicated in the therapeutic care of a patient or condition;                   (F) An opinion regarding the risks associated with not receiving the treatment procedures that are indicated in the therapeutic care of a patient or condition;                   (G) An opinion regarding the treatment procedures that are contraindicated in the therapeutic care of a patient or condition;                   (H) An opinion that a patient or condition is in need of care from a medical or other class of provider;                   (I) An opinion regarding an individual's ability to perform normal job functions and activities of daily living, and the assessment of any disability or impairment;                   (J) An opinion  regarding  the biomechanical risks to a patient, or patient population from various occupations, job duties or functions, activities of daily living, sports or athletics, or from the ergonomics of a given environment; and                   (K) Other necessary or appropriate opinions consistent with the practice of chiropractic.         
      (e) Treatment Procedures and Services.      
        (1) In the practice of chiropractic, licensees recommend, perform or oversee the performance of the treatment procedures that are indicated in the therapeutic care of a patient or patient population in order to:                  (A) Improve, correct, or optimize the biomechanical condition of the spine or musculoskeletal system of the human body including,  but  not limited to, the following:                      (i) the health and integrity of the structures of the musculoskeletal system; and                       (ii) the coordination, balance, efficiency, strength, conditioning, and functional health and integrity of the musculoskeletal system;                     (B) Promote the healing of, recovery from, or prevent the development or deterioration of abnormalities of the biomechanical condition of the spine or musculoskeletal system of the human body including, but not limited to, the following:                      (i) the structural pathology, functional pathology, or other abnormality of the musculoskeletal system;                       (ii) the effects and complicating factors of any structural pathology,   functional pathology, or other abnormality of the musculoskeletal system;                       (iii) the etiology of any structural pathology, functional pathology, or other abnormality of the musculoskeletal system; and                       (iv) the effect of any structural pathology, functional pathology, or other abnormality of the musculoskeletal system on the health of an individual patient or population of patients; and                     (C) Promote the healing of, recovery from, or prevent the development or deterioration of a subluxation complex of the spine or musculoskeletal system, including, but not limited to, the following:                      (i) the structural pathology, functional pathology, or other abnormality of a subluxation complex;                       (ii) the effects and complicating factors of any structural pathology, functional pathology, or other abnormality of a subluxation complex;                       (iii) the etiology of any structural pathology, functional pathology, or other abnormality of a subluxation complex; and                       (iv) the effect of any structural pathology, functional pathology, or other abnormality of a subluxation complex on the health of an individual patient or population of patients.           
        (2) In order to provide therapeutic care for a patient or patient population, licensees are authorized to use:                  (A) osseous and soft tissue adjustment and manipulative techniques;                   (B) physical and rehabilitative procedures and modalities;                   (C) acupuncture and other reflex techniques;                   (D) exercise therapy;                   (E) patient education;                   (F) advice and counsel;                   (G) diet and weight control;                   (H) immobilization;                   (I) splinting;                   (J) bracing;                   (K) therapeutic lasers (non-invasive, nonincisive), with adequate training and the use of appropriate safety devices and procedures for the patient, the licensee and all other persons present during the use of the laser;                   (L) durable medical goods and devices;                   (M) homeopathic and botanical medicines, including vitamins, minerals; phytonutrients, antioxidants, enzymes, nutraceuticals, and glandular extracts;                   (N) non-prescription drugs;                   (O) referral of patients to appropriate health care providers; and                   (P) other treatment procedures and services consistent with the practice of chiropractic.         
     Source Note:        The provisions of this §78.1 adopted to be effective January 29, 2015, 40 TexReg 379; amended to be effective September 13, 2015, 40 TexReg 5787; transferred effective November 1, 2018, as published in the Texas Register October 19, 2018, 43 TexReg 6963