Medicare's Coverage of Chiropractic Services
Medicare Part B covers chiropractic care, but only for one specific service: spinal manipulation to correct a subluxation. A subluxation is a misalignment of the spine that a chiropractor can detect through X-ray or other imaging. Medicare will not pay for other chiropractic treatments, such as massage, ultrasound, acupuncture, or nutritional counseling, even if a chiropractor provides them.
The coverage applies only to licensed chiropractors, and you must have a referral from your primary care doctor or another physician before your first visit. Without that referral, Medicare will deny the claim. After the first visit, you do not need a new referral for follow-up appointments, as long as they are for the same condition.
You pay 20 percent of the Medicare-approved amount for each visit after you have met your Part B deductible for the year. There is no limit on the number of visits Medicare will cover, but your chiropractor must document that the treatment is medically necessary and that you are making progress.
Key Takeaways
- Medicare Part B covers spinal manipulation for a diagnosed subluxation, but not other chiropractic services like massage or ultrasound.
- You must have a physician referral before your first chiropractic visit, or Medicare will not pay.
- You pay 20 percent coinsurance after meeting your Part B deductible, with no visit limit as long as treatment remains medically necessary.
- Your chiropractor must document progress and medical necessity in your records, or Medicare may stop covering visits.
- Medigap and Medicare Advantage plans may cover additional chiropractic services beyond what Original Medicare pays for.
How to Get a Referral From Your Doctor
Your primary care doctor or any physician who treats you can write the referral. You do not need to ask for a formal document — a note in your medical record or a straightforward letter stating that spinal manipulation is medically necessary for your condition is enough. Some doctors will write the referral during an office visit; others may do it by phone or through a patient portal.
If your doctor is hesitant, explain that you have a spine misalignment causing pain or loss of function, and that you want to try chiropractic care before considering other options. Bring any imaging results (X-rays, MRI, or CT scans) that show the subluxation, as this makes the referral easier to justify. If your doctor refuses, you can see another doctor for a second opinion.
Give the referral to your chiropractor before your first appointment. The chiropractor will keep it on file. If you lose your copy, ask your doctor's office for another one — they keep referrals in your medical record.
What Happens at Your First Visit
At your first appointment, the chiropractor will take your medical history, perform a physical exam, and likely order or review imaging to document the subluxation. The chiropractor must record the specific vertebra that is misaligned and explain why spinal manipulation will help. This documentation is what Medicare uses to determine whether to pay.
The chiropractor will also ask about your symptoms, how long you have had them, and what treatments you have already tried. Medicare is more likely to cover chiropractic care if you have not had recent spinal surgery or if you are not already receiving physical therapy for the same condition. If you are, Medicare may deny chiropractic coverage as duplicative.
Bring your Medicare card and any referral paperwork. The chiropractor's office will verify your coverage before the visit. Ask them to confirm that they accept Medicare assignment, which means they bill Medicare directly and you pay only your coinsurance — not the full fee upfront.
Costs You Will Pay Out of Pocket
Your out-of-pocket cost depends on whether you have met your Part B deductible. For 2024, the Part B deductible is $240. Once you have paid that amount toward any Part B services (doctor visits, lab work, imaging, or chiropractic care), you then pay 20 percent of the Medicare-approved amount for each chiropractic visit.
The Medicare-approved amount varies by location and by the specific service code the chiropractor uses. A typical spinal manipulation visit costs between $30 and $60 in coinsurance, though this can be higher or lower depending on your area. Ask the chiropractor's office for an estimate before your first visit.
If you have a Medigap policy, it may cover some or all of your coinsurance. If you have a Medicare Advantage plan, check your plan documents or call the plan to learn what chiropractic services are covered and what your copay will be — it may be different from Original Medicare's 20 percent coinsurance.
When Medicare Stops Paying for Chiropractic Care
Medicare will stop covering your chiropractic visits if your chiropractor cannot document that you are making progress. This means your pain should be decreasing, your range of motion should be improving, or your function should be getting better. If your condition is not changing after several visits, Medicare may deny further claims.
Your chiropractor must also show that the treatment is still medically necessary. If you have recovered from the subluxation or if the misalignment has been corrected, Medicare will not pay for maintenance visits or preventive care. Chiropractic care for wellness, injury prevention, or general health maintenance is never covered.
If Medicare denies a claim, your chiropractor will send you a notice explaining why. You have the right to appeal. Contact your chiropractor's office or call Medicare at 1-800-MEDICARE to learn how to file an appeal.
Medicare Advantage and Medigap Coverage of Chiropractic Care
Medicare Advantage plans (Part C) often cover chiropractic care beyond what Original Medicare pays for. Some plans cover additional services like massage or acupuncture, or they may have a higher visit limit. A few plans cover chiropractic care without requiring a physician referral first. Check your plan's summary of benefits or call the plan directly to learn what is covered.
Medigap policies do not typically cover chiropractic care that Original Medicare does not cover. However, if you have Original Medicare plus a Medigap plan, the Medigap plan will pay your coinsurance (the 20 percent you owe) after Medicare pays its share. This can reduce your out-of-pocket cost significantly.
If you are thinking about switching from Original Medicare to a Medicare Advantage plan, or vice versa, ask about chiropractic coverage as part of your decision. Plans change their benefits each year, so review the details during the annual enrollment period (October 15 to December 7).
Frequently Asked Questions
Do I need a new referral for each chiropractic visit?
No. You need a physician referral only before your first visit. After that, your chiropractor can continue treating you for the same condition without a new referral, as long as Medicare approves the ongoing treatment as medically necessary.
Can I see a chiropractor without a referral and pay out of pocket?
Yes. If you choose not to get a referral, you can pay the chiropractor's full fee yourself. However, Medicare will not reimburse you later, even if you obtain a referral afterward. It is best to get the referral before your first visit.
What if my chiropractor is not in the Medicare network?
Original Medicare does not have a network — any licensed chiropractor can bill Medicare. However, if the chiropractor does not accept Medicare assignment, you may have to pay the full fee upfront and then submit a claim to Medicare yourself for reimbursement. Ask the chiropractor's office before your visit.
Does Medicare cover chiropractic care for neck pain?
Yes, if the neck pain is caused by a documented subluxation of the cervical spine (upper spine). Your chiropractor must have imaging showing the misalignment and must document that spinal manipulation is treating it. Medicare does not cover chiropractic care for neck pain caused by other conditions, such as arthritis or muscle strain.
Will my Medicare Advantage plan cover chiropractic care if Original Medicare does not?
It depends on your specific plan. Some Medicare Advantage plans cover chiropractic services that Original Medicare does not, such as massage or preventive visits. Review your plan's benefits document or call the plan to confirm what is covered under your policy.