Medicare covers services provided by Doctors of Osteopathic Medicine (DOs). The federal health insurance program recognizes DOs as fully licensed physicians, treating them the same as Doctors of Medicine (MDs) for medical services. This parity ensures Medicare beneficiaries have the same access to care regardless of their physician’s degree. Coverage is determined by whether the service is medically necessary and covered under the specific part of Medicare.
The Equivalence of DOs and MDs under Medicare
Medicare regulations establish a clear legal equivalence between Doctors of Osteopathic Medicine and Doctors of Medicine. For reimbursement and service eligibility, the federal government does not differentiate between the two degrees. A beneficiary’s coverage and cost-sharing responsibilities are identical whether they are seeing a DO or an MD. While DOs receive additional education in the musculoskeletal system and may emphasize a holistic approach, both are licensed to practice the full scope of medicine.
Medicare Coverage for Standard DO Services
Medicare covers the comprehensive range of standard medical services a DO provides, mirroring the coverage structure for an MD. Most routine doctor visits, outpatient procedures, and diagnostic tests fall under Medicare Part B, which covers medically necessary physician services. After meeting the annual Part B deductible, beneficiaries typically pay 20% of the Medicare-approved amount.
If a DO acts as the attending physician during an inpatient hospital stay or in a skilled nursing facility, facility costs are covered by Medicare Part A. The DO’s professional services in that setting are billed through Part B.
For beneficiaries enrolled in a Medicare Advantage Plan (Part C), the plan must provide at least the same level of coverage as Parts A and B. However, the DO must be part of the plan’s specific provider network for the visit to be fully covered.
Specific Coverage for Osteopathic Manipulative Treatment (OMT)
The unique service a DO offers is Osteopathic Manipulative Treatment (OMT), a hands-on technique used to diagnose, treat, and prevent illness or injury by moving the body’s muscle and skeletal systems. OMT is covered under Medicare Part B when determined to be medically necessary for a specific condition.
For Medicare to cover OMT, the physician must document a diagnosis of “somatic dysfunction,” which involves impaired function of related components of the musculoskeletal system. The documentation must clearly identify the affected body regions and describe the physical findings, often using the TART acronym—Tenderness, Asymmetry, Restriction of motion, and Tissue texture abnormality.
Coverage is generally limited to active treatment for an acute or specific condition. It is not covered if the treatment is classified as maintenance therapy aimed at preventing deterioration that has already reached a maximum therapeutic benefit.
Unlike chiropractic care, which Medicare limits almost exclusively to manual manipulation of the spine, OMT coverage is broader, covering the diagnosis and treatment of somatic dysfunction across multiple body regions. The OMT service itself is covered, but any separate evaluation and management service must be distinct and medically justified to be reimbursed.
Practical Steps for Beneficiaries
Before receiving care from a DO, beneficiaries should confirm the physician’s participation status with Medicare to understand their financial responsibility. A Participating Provider (PAR) agrees to accept the Medicare-approved amount as payment in full for all covered services. This means the beneficiary is only responsible for the deductible and the 20% coinsurance.
A Non-Participating Provider (Non-PAR) accepts Medicare but can charge up to 15% more than the Medicare-approved amount, known as the limiting charge. This extra amount is billed directly to the patient, increasing the out-of-pocket cost.
If a DO has “Opted-Out” of Medicare entirely, Medicare will not pay for any of their services. In this case, the beneficiary is responsible for the full amount based on a private contract with the provider. Beneficiaries can use the Medicare website’s Physician Compare tool to verify a doctor’s participation status and avoid unexpected costs.