Spinal Decompression Therapy (SDT) is a non-surgical, motorized treatment aimed at relieving chronic back pain often caused by conditions like herniated discs, degenerative disc disease, and sciatica. The therapy uses a specialized traction table to gently stretch the spine, which creates negative pressure within the discs to promote healing and reduce nerve compression. Because a full course of treatment can involve numerous sessions and carry a high out-of-pocket cost, understanding how Medicare covers this specific therapy is a significant concern for many patients.
Medicare’s Official Stance on Coverage
Medicare generally does not cover non-surgical, motorized spinal decompression therapy because the Centers for Medicare & Medicaid Services (CMS) often classify it as investigational or lacking sufficient evidence of effectiveness. This classification means the service is typically considered not medically necessary under the rules of Original Medicare, Parts A and B. The lack of a strong National Coverage Determination (NCD) or Local Coverage Determination (LCD) supporting the use of mechanical traction devices for SDT prevents routine reimbursement.
Non-surgical SDT is distinct from other covered forms of spinal treatment, such as manual spinal manipulation performed by a chiropractor for a vertebral subluxation, which Part B may cover. It is also separate from physical therapy sessions that may include basic mechanical traction, which is sometimes covered when deemed medically necessary as part of a broader rehabilitation plan. Providers who bill for motorized SDT often face claim denials because the specific, specialized therapy is not recognized as a standard benefit.
While Medicare may cover certain surgical decompression procedures when medically necessary, the non-invasive, machine-based therapy generally falls outside approved services. In rare cases, a specific, minimally invasive procedure called percutaneous image-guided lumbar decompression (PILD) is covered, but only when performed as part of an approved clinical trial under a Coverage with Evidence Development (CED) policy.
How Different Medicare Plans Handle Therapy
The general non-coverage stance from CMS dictates how different Medicare plans approach the expense of spinal decompression therapy. Under Original Medicare, Part B handles outpatient medical services, and since motorized SDT is typically deemed not medically necessary, Part B will deny the service. When a claim is denied, the patient is responsible for the entire cost of the treatment, not just a co-payment or deductible.
Medicare Advantage plans, known as Part C, must cover all the benefits provided by Original Medicare, but they also have the ability to offer additional services. Some specific Part C plans may elect to cover non-surgical SDT if they determine it to be medically necessary, often under their expanded rehabilitative or supplemental benefits. However, this coverage is highly variable between plans and typically requires the patient to obtain prior authorization from the plan before starting treatment.
Supplemental insurance policies, such as Medigap, are designed only to cover the patient’s out-of-pocket costs for services that Original Medicare has already approved. Because SDT is usually not a covered benefit under Part B, Medigap policies will not pay for any portion of the treatment cost.
Patient Financial Responsibility and Options
Since Medicare typically denies coverage for non-surgical spinal decompression therapy, the patient assumes full financial responsibility for the service. Providers who anticipate a denial from Medicare for a service that is normally covered must issue an Advance Beneficiary Notice of Noncoverage (ABN) to the patient before treatment begins. The ABN informs the patient that Medicare is unlikely to pay and that the patient will be responsible for the full cost if they choose to proceed.
If the service is considered a “statutorily non-covered” service by Medicare, the provider may not be required to issue an ABN. However, the provider must still inform the patient of their financial liability and that they will be treated as a self-pay patient for this specific treatment. The provider is then free to charge their standard, non-Medicare rate for the sessions.
Patients seeking this treatment despite the lack of coverage can explore several financial alternatives to manage the expense. Many clinics offer in-house payment plans, allowing the patient to pay for the course of therapy in installments over time. Additionally, patients with Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs) can typically use these tax-advantaged funds to pay for the treatment, as it is considered a medical expense.