How Many Chiropractor Visits Does Medicare Cover?

Medicare is a federal health insurance program for individuals aged 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease.

Medicare Coverage for Chiropractic Care

Medicare Part B covers manual manipulation of the spine. This covers subluxation, a condition where one or more bones of the spine lose proper alignment or motion. Manual manipulation involves treatment of the spine using hands or a hand-held device to realign vertebrae and alleviate symptoms.

Medicare does not set a fixed limit on the number of covered chiropractic visits. Instead, coverage depends on the treatment being medically necessary and part of an active treatment plan. Active treatment aims to improve or correct the spinal subluxation, with a reasonable expectation of recovery or improvement in function. This distinguishes it from care focused on maintaining a condition.

Conditions for Coverage

For Medicare to cover manual spinal manipulation, the subluxation must be documented by X-ray or physical examination. This documentation helps establish the medical necessity of the treatment. The chiropractor providing services must be legally licensed by the state and be a Medicare-participating provider.

Active care, identified by an “AT” modifier on claims, is covered, while maintenance therapy is not. The initial examination and any diagnostic services performed or ordered by the chiropractor are not covered under Medicare Part B for chiropractic purposes.

Services Not Covered

Medicare does not cover many common chiropractic services. These include diagnostic procedures like X-rays, massage therapy, acupuncture, and various physical therapy modalities such as heat, ice, or electrical stimulation. Nutritional counseling, orthotics, and any adjustments to areas of the body other than the spine are also excluded from Medicare coverage. Patients are responsible for the full cost of these non-covered services. Chiropractors may ask patients to sign an Advance Beneficiary Notice (ABN) for services Medicare is not expected to cover.

Understanding Your Costs

Beneficiaries have financial responsibilities for covered chiropractic services under Medicare Part B. The annual Medicare Part B deductible must be met before Medicare pays its share. For 2025, this deductible is $257.00. After the deductible is satisfied, Medicare pays 80% of the Medicare-approved amount for the covered service. The patient is then responsible for the remaining 20% coinsurance.

If a chiropractor “accepts assignment,” they agree to accept the Medicare-approved amount as full payment for the service. In this scenario, the patient is only responsible for the deductible and coinsurance. If a chiropractor does not accept assignment, they can charge more than the Medicare-approved amount, and the patient is responsible for the difference, in addition to the deductible and coinsurance.

Accessing Covered Services

To receive covered chiropractic care, individuals can find a Medicare-participating chiropractor through the official Medicare.gov website, using the “Find Healthcare Providers” tool. This online resource allows users to search for providers in their area. Alternatively, a primary care physician may offer recommendations for chiropractors who accept Medicare.

A referral from a primary care doctor is generally not required for Medicare to cover chiropractic services. However, it is advisable to inform one’s doctor about receiving chiropractic care to ensure coordinated treatment. When billing, the chiropractor’s office will typically submit claims directly to Medicare for the covered spinal manipulation services if they accept assignment.

It is always prudent for beneficiaries to confirm a chiropractor’s Medicare participation status and their billing practices before receiving services. This proactive step helps avoid unexpected costs and ensures that the services provided align with Medicare’s coverage rules. Understanding these procedural aspects helps facilitate access to covered chiropractic care.