Does Medicare Cover Chiropractic Care?

Medicare and chiropractic care have a relationship status best described as: “It’s complicated.”
Yes, Medicare can cover chiropractic treatmentbut only a very specific slice of it, and only
when you’re playing by Medicare’s rulebook (which, to be fair, was not written for casual reading with coffee).

This guide breaks down what Original Medicare covers, what it won’t touch with a ten-foot posture stick,
how much you might pay, and how Medicare Advantage plans can change the story. Along the way, you’ll get
practical tips to avoid surprise bills and a few real-world-style experiences that feel painfully familiar
(pun intended).

The quick answer

Original Medicare (Part B) covers chiropractic care only for manual manipulation of the spine
when it’s medically necessary to correct a vertebral subluxation. That’s it. Not “plus massage.”
Not “plus an X-ray your chiropractor orders.” Not “plus a wellness package because your back likes it.”

What Original Medicare actually covers

Covered service: spinal manipulation to correct a vertebral subluxation

Under Medicare Part B, the covered chiropractic benefit is essentially an adjustmentmanual manipulation
of the spineto treat a vertebral subluxation. Medicare describes subluxation as a problem where spinal joints
fail to move properly (but joint contact remains intact). In everyday English: something’s off, your movement
is restricted, and the goal is to improve function.

Medicare’s chiropractic coverage is about treating a neuromusculoskeletal condition that needs active
treatmentmeaning the care should be expected to improve your condition, maintain improvement, or prevent further
decline in a way that’s clinically reasonable.

What “manual manipulation” means in billing terms

Chiropractors commonly bill spinal manipulation using these CPT codes:

• 98940 (spinal, 1–2 regions)
• 98941 (spinal, 3–4 regions)
• 98942 (spinal, 5 regions)

Medicare’s coverage is tied tightly to this kind of spinal manipulation. It’s not a blanket approval for everything
that happens in a chiropractic office.

What Medicare does NOT cover (the “nope” list)

This is where many people get surprised. Medicare’s chiropractic benefit is limited, and many common add-ons are
not covered when provided or ordered by a chiropractor.

Not covered when ordered by a chiropractor

• X-rays or other diagnostic tests ordered, performed, or interpreted by a chiropractor
• Massage therapy
• Acupuncture (as a chiropractic add-on)

Important nuance: Medicare may cover an X-ray or diagnostic imaging when ordered by another qualified provider
(like a physician), but Medicare generally does not pay for imaging ordered/performed/interpreted by a chiropractor
under the chiropractic benefit.

Not covered: “extraspinal” manipulation

Medicare also does not cover chiropractic manipulation of extraspinal regions (for example, certain
services billed as manipulation outside the spine). So if you’re hoping Medicare will pay for adjustments to areas
beyond the covered spinal manipulation benefit, plan on out-of-pocket costs.

Not covered: maintenance therapy (a.k.a. “it feels good so I keep going”)

One of the biggest reasons claims get denied is maintenance care. Medicare generally does not pay for
chiropractic treatment intended to maintain or prevent decline once your condition is stable. In Medicare’s eyes,
that’s not medically necessary “active treatment,” even if your back sends thank-you notes after each visit.

Medical necessity: the rules that make or break coverage

Active (corrective) treatment vs. maintenance care

Medicare coverage is centered on active/corrective treatment. A practical way to think about it:

• Active treatment: You have a problem causing pain or functional limitation, and spinal manipulation
  is expected to improve your condition within a reasonable timeframe.
• Maintenance therapy: Your condition is stable, and visits are mainly to keep you feeling good or
  prevent symptoms from coming back. Helpful? Possibly. Covered by Medicare? Usually no.

The “subluxation” requirement and documentation

Medicare expects the chiropractor’s documentation to show a spinal subluxation, demonstrated by physical exam
and/or imaging, plus evidence that treatment is medically necessary. In plain terms: Medicare wants the chart
to tell a clear story of (1) what’s wrong, (2) why an adjustment is appropriate, and (3) how you’re improving.

Many Medicare guidance materials describe documenting findings using elements often summarized as
P.A.R.T. (Pain, Asymmetry, Range of motion abnormality, Tissue/tone changes). Your chiropractor’s
notes matter because Medicare can deny payment if documentation doesn’t support medical necessity.

The AT modifier (your chiropractor’s “this is active treatment” flag)

For covered chiropractic spinal manipulation claims, Medicare requires a billing indicator to show the service is
active/corrective treatment rather than maintenance. Chiropractors commonly use the AT modifier
for this purpose on covered spinal manipulation codes.

You don’t need to memorize billing codes to get care, but you should know this: when documentation and billing
don’t match Medicare’s coverage rules, the patient is the one who gets the awkward bill (and the even more awkward
phone call).

How much does Medicare pay for chiropractic care?

Typical cost-sharing under Part B

When a chiropractic spinal manipulation is covered by Medicare Part B, you generally pay:

• After you meet your Part B deductible (the amount can change each year),
• you pay 20% coinsurance of the Medicare-approved amount,
• and Medicare pays the remaining portion of the approved amount.

Why your bill can still feel confusing

Chiropractic visits often include non-covered items (like exams, therapies, imaging, or “wellness” add-ons).
If your appointment includes both covered and non-covered services, you might see two different billing worlds
collide on the same receipt.

A smart move: ask for an itemized estimate before treatment. It’s not rudeit’s financially responsible.
Think of it like checking the menu before you order the “chef’s surprise.” Sometimes the surprise is the price.

The role of an ABN (Advance Beneficiary Notice)

If your chiropractor believes Medicare may not cover a service (especially if it looks like maintenance care),
you may be asked to sign an Advance Beneficiary Notice (ABN). An ABN is essentially a heads-up that
Medicare might deny the claim and you could be responsible for payment.

Don’t panic when you see an ABN. Read it. Ask what part of the visit is expected to be denied. Then decide whether
you still want that service. “I didn’t read what I signed” is a classic American tradition, but it’s not a great
Medicare strategy.

How Medicare Advantage (Part C) changes the game

Medicare Advantage plans must cover everything Original Medicare covers, including the limited chiropractic spinal
manipulation benefit. But many Medicare Advantage plans also offer extra benefits that can include
routine chiropractic visits beyond what Original Medicare covers.

What extra chiropractic benefits may look like

Depending on the plan, you might see:

• A set number of covered chiropractic visits per year
• Copays per visit instead of 20% coinsurance
• Network requirements (you may need an in-network chiropractor)
• Prior authorization rules or referral requirements

Translation: Medicare Advantage can provide broader chiropractic coverage, but it often comes with plan rules
that Original Medicare doesn’t have. Always check your plan’s Evidence of Coverage and provider directory.

What about Medigap?

Medigap (Medicare Supplement Insurance) policies generally help pay certain out-of-pocket costs under Original
Medicarelike coinsurancedepending on the plan type. But Medigap typically does not expand what
Medicare covers. If Original Medicare won’t cover a chiropractic service, Medigap usually won’t magically turn
it into a covered benefit.

The practical benefit: if your chiropractic spinal manipulation is covered, a Medigap plan may reduce what you pay
for deductibles/coinsurance (depending on the plan). It won’t transform massage therapy into a Medicare-covered service.

How to make Medicare chiropractic coverage work for you

A simple “before you book” checklist

• Ask what’s covered vs. not covered under Original Medicare (spinal manipulation only) and what add-ons cost.
• Confirm the visit is for active treatment, not maintenance. Ask how progress will be measured.
• Request an itemized estimate if they bundle services (adjustment + therapies + exam + gadgets).
• Ask about ABNs and when they’re used.
• If you have Medicare Advantage, confirm the chiropractor is in-network and ask about visit limits and copays.

Specific examples of what “covered” and “not covered” might look like

Here are a few common scenarios to help you map Medicare’s rules onto real life:

• Covered example: You have acute low back pain with functional limitation. Your chiropractor provides
  medically necessary spinal manipulation to correct a documented subluxation as part of active treatment.
• Not covered example: You feel fine, but you schedule monthly adjustments “just to stay aligned.”
  That’s typically maintenance careexpect to pay out of pocket.
• Mixed visit example: Adjustment (covered if criteria met) + massage (not covered) + chiropractor-ordered X-ray (not covered).
  Your bill may include both Medicare-processed and patient-responsible charges.

What if Medicare denies the claim?

Denials often happen for predictable reasons:

• The documentation doesn’t support medical necessity (no clear functional improvement plan).
• The care looks like maintenance therapy.
• The diagnosis or required subluxation details aren’t documented the way Medicare expects.
• Services billed are outside the covered chiropractic benefit.

If you receive a denial and you believe the service should have been covered, you can consider an appeal. Start by
requesting records and an explanation of benefits (EOB) details, and ask the provider’s billing office what was
submitted. Many problems come down to documentation, modifiers, or codingnot whether you “deserved” care.

Frequently asked questions

How many chiropractic visits does Medicare cover in a year?

Original Medicare does not set a simple annual visit limit for covered chiropractic spinal manipulation, but each visit
must meet Medicare’s medical-necessity rules for active treatment. In practice, repeated visits without documented
improvement can raise red flags.

Does Medicare cover chiropractic care for neck pain?

Medicare’s coverage is not based on whether it’s your neck or lower backit’s based on whether the service is
covered spinal manipulation to correct a documented subluxation and is medically necessary as active treatment.

Does Medicare cover chiropractor-ordered X-rays?

Generally, Medicare does not cover diagnostic tests ordered by a chiropractor under the chiropractic benefit.
If imaging is needed, talk with your primary care clinician or another qualified provider about whether it’s appropriate
and covered.

Is acupuncture covered by Medicare?

Medicare’s chiropractic benefit doesn’t cover acupuncture. Medicare has limited acupuncture coverage in specific situations
(such as certain chronic low back pain criteria), but that’s separate from the chiropractic service coverage rules.

Real-world experiences (composite stories) to make this feel less abstract

The rules are one thing. Living through them is another. Here are some realistic, composite experiences (based on common
Medicare billing situations) that show how chiropractic coverage can play out in real lifesometimes smoothly, sometimes
with the grace of a shopping cart with one bad wheel.

Experience #1: “I thought Medicare covered chiropractors. Turns out it covers… a chiropractor doing one thing.”

Janet, 71, booked her first chiropractic appointment after gardening turned her lower back into a grumpy, immovable plank.
She assumed Medicare would handle “the visit,” because the clinic said they “take Medicare.” What she didn’t realize is that
“taking Medicare” doesn’t mean Medicare covers every service that happens in the room.

Her appointment included an adjustment, an exam, some heat therapy, and a couple of recommended add-ons. Medicare processed
the adjustment portion, and Janet paid her coinsurance. But the restthe exam and therapiesshowed up as patient responsibility.
Janet’s takeaway (after her blood pressure returned to human levels): next time, she’d ask for an itemized estimate and clarify
which parts are Medicare-covered spinal manipulation versus office services she’d pay for herself.

Experience #2: The “maintenance care” surprise bill

Robert, 76, had a great response to a short course of chiropractic treatment after a flare of back pain. Feeling better, he
kept going every two weeks because it helped him stay active. At some point, the visits shifted from “active treatment with
measurable improvement” to “maintenance to keep symptoms away.”

That’s where the Medicare issue hit. A later claim was denied, and Robert learned that Medicare generally doesn’t pay for
maintenance therapy. The clinic wasn’t trying to trick himthey simply treated him in a way he liked. But Medicare’s idea
of “covered” is stricter than a personal preference. After that, Robert chose to continue maintenance visits out of pocket,
but now he budgets for them the way he budgets for hearing aid batteries: necessary for his life, not necessarily covered.

Experience #3: Medicare Advantage to the rescue (with fine print)

Denise, 68, enrolled in a Medicare Advantage plan that advertised “extra benefits,” including routine chiropractic visits.
She loved the idea of predictable copays and broader coverage. It worked welluntil she booked with a chiropractor she found
online who wasn’t in-network.

The plan covered chiropractic care, yesbut it required her to use network providers for the best benefits. Once Denise switched
to an in-network chiropractor, the copays were reasonable and the coverage was smoother. Her lesson: Medicare Advantage can offer
more chiropractic coverage than Original Medicare, but you have to follow the plan’s rules on networks, authorizations, and visit limits.

Experience #4: The “ABN moment” that actually helped

Thomas, 73, was asked to sign an ABN after several weeks of treatment. The clinic explained that his progress had plateaued, and
additional visits might be considered maintenance (meaning Medicare could deny them). Thomas appreciated the transparencybecause
it gave him a choice.

He decided to pause chiropractic visits, focus on a home exercise plan and walking, and follow up with his primary care clinician
about persistent symptoms. Later, when he had a new flare with functional limitations, he returned for another short course of care.
The ABN wasn’t a threat; it was information. Thomas’s takeaway: ABNs can be annoying, but they can also prevent the worst kind of
surprisean “I didn’t know I was paying for that” bill.

Bottom line

So, does Medicare cover chiropractic care? Yesbut narrowly. Under Original Medicare, the covered benefit is
essentially spinal manipulation to correct a documented subluxation as medically necessary active treatment. Many common services
people associate with chiropractic carelike chiropractor-ordered imaging, massage, extras, and maintenance visitsare typically
not covered.

If you want more extensive chiropractic benefits, a Medicare Advantage plan may offer extra coveragejust be ready
to follow network rules and plan details. And if you stick with Original Medicare, the best way to avoid surprise costs is simple:
ask what’s covered, ask what’s not, and get it itemized. Your back deserves relief, and your wallet deserves honesty.

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