Do Chiropractors Accept Medicare? Coverage & Costs

Medicare is a federal health insurance program for individuals aged 65 or older, some younger people with disabilities, and individuals with End-Stage Renal Disease. Chiropractic care, a healthcare discipline focused on the diagnosis, treatment, and prevention of musculoskeletal system disorders, particularly of the spine, is a common treatment.

Medicare Coverage for Chiropractic Services

Medicare Part B covers specific chiropractic services, primarily focusing on manual manipulation of the spine to correct a vertebral subluxation (misalignment of spinal bones). Treatment must be medically necessary, meaning it is required to diagnose or treat an illness, injury, or condition and aligns with accepted medical standards. There is no limit on the number of chiropractic adjustments Medicare will cover, provided each visit remains medically necessary.

Medicare’s coverage for chiropractic care is limited to manual spinal manipulation. Other services often associated with chiropractic visits, such as X-rays, massage therapy, and acupuncture, are generally not covered by Medicare when provided by a chiropractor. However, Medicare Part B may cover acupuncture for chronic lower back pain or physical therapy if ordered by a physician. Maintenance therapy, which aims to prevent disease, promote health, or prolong treatment effects, is also not covered.

For coverage, a chiropractor must diagnose a spinal subluxation that requires treatment. The manual manipulation must have a direct, therapeutic relationship to the patient’s condition and offer a reasonable expectation of recovery or functional improvement. Medical necessity can be documented through a physical exam or, in some cases, an X-ray.

Finding a Medicare-Accepting Chiropractor

Locating a chiropractor who accepts Medicare involves a few steps to ensure coverage. The official Medicare website, Medicare.gov, features a “Physician Compare” tool. This tool allows individuals to search for Medicare-enrolled healthcare providers, including chiropractors.

When using the Physician Compare tool, users can input their location and search for “chiropractic” services. Search results display chiropractors, often noted as accepting Medicare assignment. It is also recommended to contact chiropractic offices directly to inquire about their Medicare participation status before scheduling an appointment. Confirming enrollment is important to ensure services are eligible for potential coverage.

Cost and Billing Considerations

Once Medicare Part B covers a chiropractic service, financial responsibility involves a deductible and coinsurance. After the annual Part B deductible is met, Medicare pays 80% of the Medicare-approved amount for covered manual spinal manipulation. The patient is responsible for the remaining 20% coinsurance. For example, if the Medicare-approved amount is $50, Medicare pays $40, and the patient owes $10 after meeting their deductible.

“Medicare Assignment” means a chiropractor agrees to accept the Medicare-approved amount as full payment for covered services. When a chiropractor accepts assignment, Medicare pays its share directly to the provider, and the patient is billed only for the coinsurance and any unmet deductible. This arrangement results in lower out-of-pocket costs for the beneficiary.

If a chiropractor does not accept Medicare Assignment, they are considered a “non-participating” provider. These providers can charge more than the Medicare-approved amount, up to a “limiting charge” (15% above the non-participating Medicare-approved rate). In such cases, the patient may need to pay the full bill upfront, and Medicare will reimburse the patient directly for its share. Understanding a chiropractor’s Medicare participation status and billing practices is essential for managing potential out-of-pocket expenses.