Does Medicare Cover Chiropractic Services?

Medicare, a federal health insurance program, provides coverage for millions of Americans, primarily those aged 65 or older and certain younger individuals with disabilities. This program assists with the costs of various medical services, including hospital stays, doctor visits, and prescription drugs. Chiropractic care, a healthcare discipline focused on musculoskeletal health, particularly of the spine, is a common form of complementary health care. Understanding how Medicare applies to these services is important for beneficiaries seeking spinal adjustments.

Medicare’s Specific Chiropractic Coverage

Medicare Part B, which covers medical services, includes specific chiropractic services. This coverage is strictly limited to manual manipulation of the spine. The manipulation must be medically necessary to correct a vertebral subluxation, a condition where spinal joints fail to move properly but remain intact. Medicare defines medical necessity as treatment needed to diagnose or treat an illness, injury, condition, or disease, meeting accepted medical standards.

The coverage applies only when the chiropractic care is part of an “active treatment” to correct a subluxation. Active treatment aims to improve or arrest the progression of a patient’s condition, with a reasonable expectation of recovery or functional improvement. Medicare does not cover “maintenance therapy,” which seeks to prevent disease, promote health, prolong life, or maintain/prevent deterioration of a chronic condition when further clinical improvement is not expected. Claims for maintenance therapy are not considered medically reasonable or necessary and are typically denied.

Medicare does not cover other services or tests a chiropractor might offer, even if medically necessary. This includes X-rays, massage therapy, physical therapy, and nutritional counseling. These services are excluded from Medicare coverage when provided or ordered by a chiropractor.

Your Financial Responsibility for Chiropractic Services

When Medicare Part B covers chiropractic services, beneficiaries have specific financial obligations. After meeting the annual Medicare Part B deductible, which is $257 in 2025, patients typically pay 20% of the Medicare-approved amount for the covered manual spinal manipulation. The remaining 80% is paid by Medicare.

The concept of “Medicare Assignment” is important for understanding out-of-pocket costs. Chiropractors who “accept assignment” agree to accept the Medicare-approved amount as full payment for covered services. This means they cannot bill the patient for more than the deductible and the 20% coinsurance. If a chiropractor does not accept Medicare assignment, they are considered “non-participating”. While they can still treat Medicare beneficiaries, they are not obligated to accept Medicare’s approved amount as full payment.

Non-participating chiropractors can charge up to 15% more than the Medicare-approved amount, known as the “limiting charge.” In such cases, the patient is responsible for the Part B deductible, the 20% coinsurance, and any amount up to the limiting charge. Chiropractors cannot “opt-out” of Medicare entirely; they must either participate or be non-participating. For any services not covered by Medicare, the patient is 100% responsible for the cost. These non-covered services do not count towards the Medicare deductible.

Navigating Chiropractic Care with Medicare

Accessing chiropractic care through Medicare involves understanding how to locate qualified providers and the claims process. Beneficiaries should begin by finding a chiropractor who accepts Medicare. The official Medicare website offers a provider search tool, “Medicare.gov Physician Compare,” where individuals can search for chiropractors in their area. Confirm with the chiropractor’s office directly that they accept Medicare assignment and are familiar with Medicare’s specific coverage rules for chiropractic care. Inquiring about potential out-of-pocket costs for services not covered by Medicare upfront can help manage financial expectations.

The chiropractor’s office typically handles the submission of claims directly to Medicare on behalf of the patient. These claims are submitted using a standard form, such as the CMS-1500 form.

After Medicare processes a claim, beneficiaries receive an Explanation of Benefits (EOB). This document details the services received, the amount billed by the provider, the amount Medicare approved, what Medicare paid, and the amount the patient owes. The EOB is not a bill, but rather a summary of how the claim was processed. Reviewing the EOB carefully and keeping records of visits and payments can help beneficiaries track their expenses and ensure accurate billing.