Whether a chiropractor can order a Magnetic Resonance Imaging (MRI) scan is a common question for patients seeking non-surgical care. A chiropractor (DC) is a licensed healthcare provider specializing in the diagnosis and treatment of neuromusculoskeletal conditions, primarily through manual adjustment. An MRI uses magnetic fields and radio waves to create detailed images of soft tissues, which is critical for seeing beyond bone structure. The authority of a DC to order this advanced imaging is not uniform across the United States, as it is strictly governed by state licensing laws and regulations.
Scope of Practice and Imaging Authority
The ability of a chiropractor to directly order an MRI is determined entirely by the scope of practice defined by each state’s licensing board. This legal framework dictates which diagnostic procedures a DC is authorized to initiate. The regulations across the nation generally fall into three categories, creating a patchwork of authority for advanced imaging like MRI and Computed Tomography (CT) scans.
In some jurisdictions, the scope of practice includes full prescriptive authority, allowing the DC to directly order an MRI when clinically necessary. Other states place stricter limits, requiring the chiropractor to co-manage care or obtain a referral from a primary care provider (PCP) or medical specialist before ordering. The most restrictive scenario limits the scope of practice largely to ordering and taking plain film X-rays only.
While many jurisdictions technically allow DCs to order CT and MRI scans, practical application is often complicated by the policies of individual imaging centers and insurance carriers. Even if a chiropractor has the legal authority to place the order, the imaging facility may still require a referral from a medical doctor (MD) or Doctor of Osteopathic Medicine (DO) for scheduling or insurance coverage purposes.
The Clinical Rationale for Advanced Imaging
A chiropractor seeks advanced imaging when a physical examination and standard X-rays are insufficient for a precise diagnosis or when a serious underlying condition is suspected. X-rays visualize bone alignment and fractures but provide limited information regarding soft tissues. Magnetic Resonance Imaging is superior for evaluating structures like intervertebral discs, nerve roots, the spinal cord, ligaments, and muscles.
The clinical justification for recommending an MRI often involves ruling out serious pathology, commonly referred to as “red flags.” These might include a suspected spinal tumor, an infection, or a significant fracture that was not visible on plain film. An MRI is also medically necessary when a patient presents with progressive neurological symptoms, such as significant motor weakness, numbness, or tingling that radiates into the limbs, known as radiculopathy. These symptoms suggest possible compression of a nerve root or the spinal cord.
A common application for MRI is to confirm or detail the extent of a suspected disc herniation. If a patient’s pain persists beyond approximately 45 days despite receiving conservative care, an MRI becomes a reasonable next step to pinpoint the exact source of the lingering symptoms. The detailed images allow the chiropractor to refine the diagnosis, tailor the treatment plan, or determine if a referral to a spine surgeon or neurologist is warranted.
Navigating the Referral Process
When a chiropractor determines an MRI is necessary but cannot directly order it, the patient is guided through a referral process requiring collaboration with other providers. The chiropractor compiles a detailed clinical justification report outlining the patient’s history, physical exam findings, and the specific reasons the MRI is needed. This documentation supports the medical necessity of the scan.
The chiropractic office sends this report to the patient’s primary care physician or a specialist, such as an orthopedist or neurologist. The medical doctor reviews the data and, if they agree, places the official order for the MRI. This step is often necessary because many health insurance plans only authorize coverage for advanced imaging if the request originates from an MD or DO, regardless of the DC’s legal authority.
This sequence highlights the concept of co-management, where multiple healthcare professionals work together to ensure the patient receives the most appropriate diagnostic testing and treatment. The patient facilitates communication between their chiropractor and the ordering physician, often by ensuring insurance requirements for prior authorization are met. This collaborative approach guarantees access to the advanced imaging required for a precise diagnosis and effective care.