Will Medicare Cover Chiropractic Services?

Avatar photo Dr. Robert Ehle

For individuals aged 65 and above, as well as those on Medicare disability, the prospect of Medicare covering chiropractic services offers a ray of hope for managing the challenges of pain and discomfort that often accompany this phase of life. Specifically, Medicare Part B extends its coverage to include spinal manipulation performed by chiropractors, presenting a valuable option for addressing musculoskeletal issues. This coverage holds particular significance as it aligns with a time when aches and pains can become overwhelming, potentially hindering one’s ability to fully engage in daily activities and enjoy life to the fullest.

It’s worth noting that the landscape of chiropractic care providers includes both ‘participating providers’ and ‘non-participating providers’. A participating provider offers the service and subsequently submits the bill to Medicare for direct payment. On the other hand, a non-participating provider requires payment at the time of service, with the provider later billing Medicare for reimbursement. Medicare then follows its established payment schedule to refund the patient the amount paid for the service. Understanding the distinction between these provider types can help you navigate the process and make informed choices about your chiropractic care.


Does Medicare Cover Chiropractic Care?

If you’re a Medicare beneficiary, you’ll be pleased to know that Medicare Part B covers spinal manipulation performed by chiropractors. This coverage extends to those aged 65 and over, as well as individuals on Medicare disability. This service becomes particularly valuable during a stage of life when dealing with discomfort can significantly impact daily activities and quality of life.


Chiropractors can be classified as either ‘participating providers’ or ‘non-participating providers.’ A participating provider directly bills Medicare for the service and receives payment from Medicare. In contrast, a non-participating provider requires upfront payment, and Medicare later refunds the covered amount according to its payment schedule.


What Parts of Medicare Cover Chiropractic Care?

Navigating the landscape of Medicare coverage for chiropractic care requires a clear understanding of the different parts of Medicare and their specific domains. Medicare Part B is tailored to encompass doctor visits that occur outside of a hospital setting, providing coverage for a diverse range of outpatient medical services. However, it’s important to note that hospital visits, including chiropractic care received within a hospital, are categorized under Medicare Part A, which includes chiropractic care. Understanding that chiropractic care is a covered service under Part B is crucial to keep in mind, particularly if you have Medicare coverage limited to Part A. In such cases, access to chiropractic services may not be available under your current plan. By comprehending the coverage areas of different Medicare parts, you can make informed decisions about your healthcare options and ensure that you receive the appropriate care for your needs.


What Chiropractic Services Does Medicare Not Cover?

Medicare Part B extends coverage for specific chiropractic services, notably including spinal manipulation—a cornerstone of chiropractic care. However, it’s important to recognize that there are additional services provided by chiropractors that fall beyond the scope of Medicare coverage. While spinal manipulation receives coverage, certain standard medical procedures performed by chiropractors may not be covered under Medicare Part B.

For instance, the initial history and examination—a crucial step in understanding your condition and potential responsiveness to spinal manipulation—are not covered by Medicare. Similarly, X-rays conducted by a chiropractor, essential for comprehending spine and bone conditions and identifying sources of pain and dysfunction, are not covered either. These initial assessments, alongside X-rays, are considered cash services and are not included in Medicare coverage.

Nevertheless, once these diagnostic procedures are completed, the subsequent spinal manipulation performed by a chiropractor becomes eligible for Medicare coverage.

Furthermore, it’s important to note that there are additional services offered by chiropractors, such as acupuncture, cold laser therapy, shock wave therapy, massage and e-stim muscle therapy, that are not covered by Medicare. These services, often considered cash services, may provide alternative avenues for addressing specific health concerns beyond the scope of Medicare coverage. Being aware of these coverage boundaries empowers you to make informed decisions about your chiropractic care and explore available options to best suit your needs.


How Much Does a Chiropractic Visit Typically Cost?

Determining the cost of a chiropractic visit involves a combination of factors, and it’s prudent to initiate a conversation with the chiropractor’s office to gain clarity on the expenses involved. If you’re contemplating chiropractic treatment, reaching out to the office directly to inquire about the cost of services is a proactive step. They can provide you with a breakdown of which services will be covered by Medicare and which ones will not, enabling you to make informed financial decisions.

Under Medicare Part B, covered chiropractic services are typically paid at 80% of the approved amount, leaving a 20% co-insurance responsibility on your end. However, having supplemental insurance coverage in conjunction with Medicare Part B can mitigate this co-payment burden. Supplemental insurance, commonly referred to as Medigap, is designed to cover the 20% co-payment, easing the financial impact of chiropractic care.

If you choose a participating provider, they will take care of the billing process by submitting claims to Medicare and your supplemental insurance. This streamlined approach ensures that you receive the appropriate coverage and benefits without unnecessary hassle.

It’s important to acknowledge that the cost of a chiropractic visit may vary based on the complexity of your case and the nature of the services provided. For instance, if you’re seeking relief from neck pain alone, the cost might differ from a visit that addresses both neck and low back pain. By proactively engaging with the chiropractor’s office and understanding the range of costs associated with your specific needs, you can embark on your chiropractic journey well-informed and financially prepared.


How Many Chiropractic Visits Will Medicare Pay For?

Understanding the extent of chiropractic care coverage under Medicare involves considering the specific diagnosis associated with your condition. Medicare bases the number of allowable chiropractic visits on the diagnosis provided by your healthcare provider. This approach ensures that the coverage aligns with the complexity and needs of your unique health situation.

For instance, if you’re diagnosed with a relatively uncomplicated condition Medicare may provide coverage for up to 12 chiropractic visits. However, when faced with a more intricate diagnosis such as sciatica or degenerative disc disease, Medicare may extend coverage for a greater number of visits, potentially up to 30.

It’s important to note that certain diagnoses may require additional validation through X-rays or imaging to establish the necessity of chiropractic care. Degenerative disc disease, for example, often requires imaging to confirm the diagnosis. By linking the coverage allowance to the diagnosis and its corresponding requirements, Medicare ensures that you receive the appropriate level of care tailored to your specific health needs. This nuanced approach underscores the importance of accurate diagnosis and the role it plays in determining the extent of chiropractic care coverage under Medicare.


Book a Chiropractic Appointment Today

Prioritize your well-being and take advantage of the chiropractic coverage offered by Medicare. To embark on a journey towards better health and pain relief, request an appointment with Ascent Chiropractic today. Begin your path to improved mobility, comfort, and overall vitality.

Avatar photo

Dr. Robert Ehle

Dr Ehle has 30+ years’ experience in Chiropractic with advanced studies in nutrition, homeopathy, and applied kinesiology (muscle testing). His practice has been in the same location at Interstate 40 and Georgia since 1998. He and his wife Frances moved to Amarillo in 1993 from Houston, Texas. They wanted a smaller more cohesive community to raise their 3 children Eric, Justin, and Lauren.