How Many Chiropractic Visits Does Medicare Cover?
Navigate Medicare coverage for chiropractic care. Get clarity on what spinal adjustments are covered, the conditions for coverage, and your financial responsibilities.
Medicare is a federal health insurance program in the United States for individuals aged 65 or older, and younger people with certain disabilities or medical conditions. This program helps with healthcare costs, though it does not cover all medical expenses. Chiropractic care is a healthcare profession focused on diagnosing, treating, and preventing mechanical disorders of the musculoskeletal system, particularly the spine. It often involves manual therapy, such as spinal manipulation, to restore joint mobility and alleviate pain.
What Medicare Covers for Chiropractic
Medicare Part B covers specific chiropractic services. This coverage is limited to manual spinal manipulation by a chiropractor or other qualified provider. The manipulation must correct a vertebral subluxation and be medically necessary. A subluxation is a condition where spinal joints do not move properly, and it may cause neck or back pain.
Additionally, Medicare does not cover other services or tests ordered by a chiropractor, such as X-rays, massage therapy, or acupuncture. Maintenance or preventive chiropractic care is also not covered. If a chiropractor recommends non-covered services, individuals typically pay out-of-pocket.
Coverage Limitations and Requirements
Medicare does not impose a fixed annual limit on chiropractic visits. Coverage is contingent upon medical necessity and “active treatment” to correct a subluxation. Active treatment aims to improve or arrest a patient’s condition, with a reasonable expectation of recovery or functional improvement.
For coverage, a chiropractor must document the subluxation, which can be shown by X-rays or a physical examination. Documentation must include patient history, musculoskeletal evaluation, subluxation diagnosis, and a treatment plan. The treatment plan should outline visit frequency, goals, and how treatment effectiveness will be measured.
Once the condition is corrected or further improvement is not expected, Medicare coverage ceases. Subsequent care is considered non-covered maintenance therapy.
Your Costs for Chiropractic Care
Under Original Medicare Part B, after meeting the annual deductible, individuals pay a portion of the cost for covered chiropractic services. Medicare typically covers 80% of the approved amount for manual spinal manipulation, leaving the patient responsible for the remaining 20% coinsurance. Providers who accept Medicare assignment agree to the Medicare-approved amount, which helps control costs for beneficiaries.
Medicare Supplement (Medigap) policies can help cover some of these out-of-pocket costs, such as the 20% coinsurance. Medicare Advantage (Part C) plans are an alternative to Original Medicare. They must cover the same services but may offer additional chiropractic benefits and have different cost-sharing structures, such as copayments.