Medicare offers coverage for many medical services, but when it comes to chiropractic care, the answer is a qualified “yes.” This coverage is highly specific and limited to a very narrow scope of treatment. Understanding these limitations is important for beneficiaries to manage their healthcare expectations and costs.
The Specific Chiropractic Services Covered by Medicare Part B
The federal program strictly limits chiropractic benefits to services falling under Medicare Part B. This coverage is confined to a single type of service: the manual manipulation of the spine, often referred to as a chiropractic adjustment. This manipulation must be performed by a licensed chiropractor or other qualified provider.
Medicare only covers a spinal adjustment for the correction of a subluxation. A subluxation is defined as a spinal motion segment where the alignment, movement integrity, or physiological function is altered, though the joint surfaces remain in contact. For coverage, the provider must document that the subluxation is medically necessary to treat a neuromusculoskeletal condition, meaning the treatment is active and designed to improve or arrest the condition. Medicare does not impose a limit on the number of medically necessary adjustments a patient can receive.
Services Medicare Will Not Pay For
If a chiropractor provides a service, Medicare will not necessarily cover it. Medicare will not pay for any service other than the manual manipulation of the spine to correct a subluxation. Patients are responsible for 100% of the cost for many common chiropractic office procedures.
Medicare explicitly excludes maintenance therapy, which is care provided after a condition has stabilized and is intended to prevent disease or prolong the effects of treatment. Other non-covered services include:
- Diagnostic tests, such as X-rays, magnetic resonance imaging (MRI), or laboratory work, if ordered by the chiropractor.
- Physical therapy modalities, including hot or cold packs, electrical stimulation, ultrasound, and massage therapy.
- Nutritional counseling.
Finding a Chiropractor Who Accepts Medicare
Since Medicare only covers the adjustment, finding a provider who accepts Medicare is the next step. Chiropractors have the choice of whether or not to “accept assignment.” A provider who accepts assignment agrees to accept the Medicare-approved amount as the full payment for the covered service.
The best method for locating such a provider is to use the official Medicare website’s “Physician Compare” tool. This tool allows beneficiaries to search for chiropractors in their area and verify their participation status. Choosing a provider who accepts assignment ensures that you will not be balance-billed for more than the deductible and coinsurance for the spinal manipulation. If a chiropractor does not accept assignment, they may charge more than the Medicare-approved amount, leaving the patient responsible for the difference.
Patient Responsibility: Understanding Coinsurance and Deductibles
Even for the single covered service—manual manipulation of the spine—patients are responsible for certain out-of-pocket costs under Original Medicare Part B. Before Medicare begins to pay, the patient must first satisfy the annual Part B deductible, which must be paid by the patient before coverage kicks in.
Once the deductible has been met, Medicare pays 80% of the Medicare-approved amount for the covered spinal manipulation. The patient is then responsible for the remaining 20% coinsurance. If a patient has supplemental insurance, such as a Medigap policy, it may cover some or all of this 20% coinsurance. Medicare Advantage Plans (Part C) must cover at least the same services as Original Medicare, but they may have different cost-sharing structures, such as fixed copayments, which should be verified with the specific plan.