Does Medicare Pay for Chiropractic Care?

Medicare, the federal health insurance program, provides coverage for millions of Americans. Many beneficiaries seek clarity on coverage for various services, including chiropractic care. Understanding how Medicare addresses chiropractic services is important for planning healthcare needs and managing financial responsibilities. This article clarifies Medicare’s specific provisions for chiropractic treatment, outlining what is covered, conditions for coverage, associated costs, and practical steps for navigating care.

Specifics of Medicare Chiropractic Coverage

Medicare Part B covers specific chiropractic services, primarily manual manipulation of the spine. This coverage applies when a chiropractor performs adjustments to correct a vertebral subluxation, which is a misalignment of spinal joints. The treatment must be medically necessary for an active condition causing symptoms, not for general wellness or prevention. Manual manipulation involves a controlled thrust to the spine using hands or a device, aiming to realign vertebrae and alleviate symptoms.

Medicare limits its coverage to manual manipulation of the spine. Services such as X-rays, massage therapy, or acupuncture, even if ordered by a chiropractor, are generally not covered. Medicare also does not cover “maintenance care,” defined as care no longer medically necessary to correct a subluxation but for general wellness or to prevent symptom recurrence. Beneficiaries are responsible for the full cost of these non-covered services.

Eligibility Requirements for Coverage

For Medicare to cover manual spinal manipulation, specific conditions must be met. The treatment must address a diagnosed vertebral subluxation causing symptoms and requiring active intervention. This diagnosis must be thoroughly documented by the chiropractor, detailing the subluxation’s nature. Documentation typically includes findings from physical examination, such as asymmetry, misalignment, or abnormal range of motion.

The chiropractic services must be performed by a chiropractor or other qualified provider licensed in their state and enrolled in the Medicare program. Documentation by the chiropractor is essential to support the medical necessity of the treatment and subluxation diagnosis for Medicare billing purposes.

Financial Aspects of Chiropractic Care

Covered chiropractic services fall under Medicare Part B, which is medical insurance. Beneficiaries are responsible for an annual deductible before Medicare begins to pay its share. For 2025, the Medicare Part B deductible is $257. Once this deductible has been met, Medicare typically pays 80% of the Medicare-approved amount for the covered spinal manipulation.

The patient is responsible for the remaining 20% as co-insurance. Services not covered by Medicare, such as X-rays, massage therapy, or maintenance care, are the patient’s full financial responsibility. Understanding these financial details helps beneficiaries anticipate their out-of-pocket costs for chiropractic treatment.

Navigating Your Chiropractic Visits

When seeking chiropractic care under Medicare, beneficiaries can use the Medicare.gov Physician Compare tool to locate chiropractors. These providers must be enrolled in Medicare and accept assignment, meaning they agree to accept Medicare’s approved amount as full payment for services. A referral from a primary care physician is generally not required for covered chiropractic services.

The chiropractor’s office typically submits claims directly to Medicare for covered services. If a chiropractor believes a service may not be covered, such as maintenance care, they should issue an Advance Beneficiary Notice of Non-coverage (ABN). This form informs the patient that Medicare might deny payment, making the patient responsible for the cost. Patients should understand and sign an ABN before receiving services that may not be covered.