Does Medicare Cover Chiropractors? What Part B Pays For and What It Doesn't

If your back or neck hurts and you have a red, white and blue Medicare card, the short answer is yes, Medicare does cover chiropractic care. But it covers one specific service, and many people are surprised by what's left out. Knowing the rule before your first visit can save you a bill you didn't expect.

What Original Medicare pays for

Medicare Part B covers manual manipulation of the spine by a chiropractor or other qualified provider when it's needed to correct a subluxation, meaning one or more bones of the spine have moved out of position. That is the only chiropractic service Original Medicare covers.

After you meet the yearly Part B deductible, you usually pay 20% of the Medicare-approved amount for each covered visit.

Medicare does not pay for other services or tests a chiropractor orders, such as X-rays, massage therapy or acupuncture. (Acupuncture has its own separate Part B rules for chronic low back pain, and a chiropractor can't bill it.)

Treatment that helps vs. "maintenance"

Medicare pays for spinal manipulation while it is active treatment, meaning it is expected to improve your condition. Once you've stopped improving and visits are only to keep you where you are, Medicare usually treats that as maintenance care and stops paying.

When the chiropractor thinks Medicare may not pay for a visit, they should give you a form called an Advance Beneficiary Notice of Noncoverage (ABN) before treating you. It lets you decide whether to go ahead and pay yourself. Read it before you sign; it's your chance to ask questions.

Medicare Advantage and Medigap work differently

Medicare Advantage (Part C) plans, sold by private companies, must cover everything Original Medicare covers, including spinal manipulation for subluxation. Some add extra "routine" chiropractic visits as a bonus benefit. These plans usually use a network, may require a referral or approval, and set their own copays, so check your plan's Evidence of Coverage.

Medigap (Medicare Supplement) plans don't add chiropractic services. But many of them help pay your 20% share for the visits Original Medicare covers.

Checklist: what to check before you book

• Do you have Original Medicare or a Medicare Advantage plan? Look at the card you use at the doctor.
• Does the chiropractor accept Medicare, and do they accept assignment (the Medicare-approved amount as full payment)?
• If you have Medicare Advantage, is the chiropractor in your plan's network, and do you need a referral or approval first?
• Does your Advantage plan include extra routine chiropractic visits? How many, and at what copay?
• Have you met your Part B deductible this year?
• Will the clinic charge for X-rays, massage or other extras that Medicare won't cover?

If it isn't covered

If your visits are considered maintenance, or you need a service Medicare doesn't pay for, ask the clinic for its self-pay price per visit and whether it offers package rates. You can also ask your doctor whether physical therapy, which Part B covers under different rules, is a fit for your pain. If you think a claim was wrongly denied, you have the right to appeal; your Medicare Summary Notice explains how.

When you're ready, Find a chiropractor near you that accepts Medicare. Tell us your plan and ZIP code, and we'll match you with a clinic. The clinic checks your benefits before your first visit.

Sources

• Medicare.gov: Chiropractic services
• CMS: Advance Beneficiary Notice of Noncoverage (ABN)
• NCCIH (NIH): Spinal Manipulation: What You Need To Know