Medicare's Coverage of Chiropractic and Physical Therapy
Medicare Part B covers physical therapy, but it does not cover chiropractic care. The one exception is a single chiropractic X-ray to diagnose a subluxation (misalignment of the spine), which Medicare will pay for if a doctor orders it. After that X-ray, if your doctor refers you to physical therapy instead, Medicare covers those visits up to a yearly limit.
This distinction matters because many people use the terms interchangeably, but Medicare treats them very differently. Physical therapy is performed by a licensed physical therapist and focuses on restoring movement and function after injury or surgery. Chiropractic care involves spinal manipulation and adjustment, which Medicare does not consider medically necessary for most conditions.
Key Takeaways
- Medicare Part B covers physical therapy with a doctor's referral, but does not cover chiropractic manipulation or adjustment.
- Medicare will pay for one chiropractic X-ray to diagnose a spine misalignment, but only if ordered by your doctor.
- Physical therapy visits are subject to a yearly limit, and you pay 20 percent of the cost after you meet your Part B deductible.
- If you want chiropractic care beyond the single X-ray, you will need to pay out of pocket or carry a supplemental insurance plan that covers it.
- Your doctor must refer you to physical therapy for Medicare to cover the visits.
How Medicare Covers Physical Therapy
Physical therapy is covered under Medicare Part B when your doctor refers you. You can receive physical therapy in an outpatient clinic, a hospital outpatient department, or your home. Your doctor does not have to be a specialist — your primary care doctor can write the referral.
You pay 20 percent of the Medicare-approved amount for each visit after you have met your Part B deductible for the year. The deductible is the same whether you use physical therapy or any other Part B service. If you have a Medigap or Medicare Advantage plan, your out-of-pocket cost may be lower, depending on your plan's coverage.
Medicare does set a yearly limit on how many physical therapy visits it will cover. The limit changes year to year and can vary based on your condition and whether your therapist requests an exception. Your physical therapist or doctor's office can tell you how many visits Medicare will cover in your specific situation.
The Single Chiropractic X-Ray Medicare Will Pay For
Medicare covers one chiropractic X-ray per year if your doctor orders it to diagnose a subluxation of the spine. A subluxation is a partial dislocation or misalignment. Your doctor must document that the X-ray is medically necessary and order it themselves — you cannot straightforward ask a chiropractor to take one and bill Medicare.
This coverage applies only to the X-ray itself, not to any treatment that follows. If the X-ray shows a problem, your doctor may refer you to physical therapy, which Medicare will cover. But Medicare will not pay for the chiropractor to perform spinal manipulation or adjustment based on that X-ray.
What You Pay Out of Pocket for Chiropractic Care
If you want chiropractic manipulation or adjustment beyond the single X-ray, you will pay the full cost yourself unless you have additional insurance. Many supplemental Medigap plans do not cover chiropractic care either, so check your plan documents before assuming you are covered.
Some Medicare Advantage plans (Part C) do offer chiropractic benefits as an added feature. If you have a Medicare Advantage plan, review your plan's summary of benefits or call the plan directly to see whether chiropractic visits are included and what you would pay per visit.
Chiropractors typically charge between $30 and $200 per visit depending on your location and the type of service, though prices vary widely. If you are considering chiropractic care, ask the chiropractor's office for their fee schedule upfront so you know what to expect.
When Your Doctor Might Refer You to Physical Therapy Instead
Many conditions that people treat with chiropractic care — back pain, neck pain, whiplash — can also be treated with physical therapy. Your doctor may recommend physical therapy because it is covered by Medicare and because physical therapists use exercises and movement to address the underlying problem rather than just manipulating the spine.
Physical therapy often involves a series of visits where you learn exercises to do at home, stretching routines, and techniques to prevent the problem from returning. Your therapist will track your progress and adjust your treatment plan as you improve. This approach appeals to many doctors because it gives you tools to manage your condition long-term.
If your doctor recommends physical therapy and you prefer chiropractic care, you can discuss that preference with your doctor. Some people use both — physical therapy covered by Medicare and chiropractic care paid out of pocket — though you should talk to both providers about whether that combination makes sense for your specific condition.
How to Get a Physical Therapy Referral from Medicare
Start by seeing your doctor and describing your symptoms or the injury you are recovering from. Your doctor will examine you and decide whether physical therapy is appropriate. If your doctor agrees, they will write a referral that includes the diagnosis, the type of therapy needed, and how many visits they think you will need.
Take that referral to a physical therapy clinic or hospital outpatient department that accepts Medicare. The clinic will verify your Medicare coverage and tell you what your out-of-pocket cost will be. Your first visit will include an evaluation where the therapist assesses your condition and creates a treatment plan.
You do not need to choose a specific therapist in advance. Your doctor's referral is to physical therapy as a service, and the clinic will assign you to an available therapist. If you have a preference or a therapist you have worked with before, you can ask the clinic to request that person.
Medicare Advantage Plans and Chiropractic Coverage
Medicare Advantage plans (Part C) are an alternative to Original Medicare, and they often include benefits that Original Medicare does not. Some Medicare Advantage plans do cover chiropractic care, though the number of visits and your out-of-pocket cost vary by plan.
If you are enrolled in a Medicare Advantage plan and interested in chiropractic care, call your plan's customer service number — it is on your insurance card — and ask whether chiropractic visits are covered. Ask how many visits per year are covered, what you pay per visit, and whether you need a doctor's referral. Plans change their benefits each year, so check your current plan documents or call to confirm.
If you are thinking about switching to a Medicare Advantage plan because of chiropractic coverage, remember that these plans also have networks. You will need to use a chiropractor in your plan's network, or you will pay more or the full cost. Ask the plan for a list of in-network chiropractors in your area before you enroll.
Frequently Asked Questions
Can I see a chiropractor without a doctor's referral?
Yes, you can see a chiropractor without a referral. However, Medicare will not pay for the visit. You will pay the full cost out of pocket. If you want Medicare to cover any part of your care, you need a doctor's referral for physical therapy instead.
Does Medicare cover massage therapy?
No, Medicare does not cover massage therapy. Physical therapy is covered, but massage is not considered a separate service under Medicare Part B. Some Medicare Advantage plans may offer massage as an added benefit, so check your plan if you have one.
What if my physical therapy visits run out before I feel better?
Your physical therapist or doctor can request an exception to the yearly visit limit if you are making progress and need more visits. This is called an exception request or an appeal. Your therapist will document your progress and explain why additional visits are medically necessary. Medicare reviews these requests, and approval is not may provide, but many are approved.
Do I need a referral every time I go to physical therapy?
No, you need one referral from your doctor at the start. That referral covers your course of treatment. You do not need a new referral for each visit, though your therapist may contact your doctor during your treatment to update them on your progress.
Can I choose any physical therapist, or do they have to be in a network?
If you have Original Medicare, you can see any physical therapist who accepts Medicare. There is no network restriction. If you have a Medicare Advantage plan, you may need to use an in-network therapist, or you will pay more. Check your plan documents or call your plan to confirm.