Medicare Part B covers some chiropractic services, but only spinal manipulation for subluxation

Medicare Part B will pay for chiropractic care, but only for one specific treatment: spinal manipulation to correct a vertebral subluxation (a misalignment of the spine). Medicare does not cover other chiropractic services like X-rays ordered by a chiropractor, massage, stretching, or nutritional counseling, even if a chiropractor provides them.

You must see a chiropractor who is enrolled in Medicare and accepts Medicare patients. Not all chiropractors do. Before your first visit, call the chiropractor's office and confirm they take Medicare and that they will bill Medicare directly.

Medicare Part A (hospital insurance) does not cover any chiropractic services. Part D (prescription drug coverage) does not either. If you have a Medigap or Medicare Advantage plan, that plan may cover additional chiropractic services beyond what Part B covers, but you will need to check your plan documents or call your plan directly.

Key Takeaways

  • Medicare Part B covers spinal manipulation for vertebral subluxation only, not other chiropractic treatments like massage, stretching, or X-rays.
  • You must see a Medicare-enrolled chiropractor who accepts Medicare patients, and the chiropractor must document the subluxation and medical need for treatment.
  • Medicare typically covers up to 12 visits per year for spinal manipulation, though your doctor may request more visits if medically necessary.
  • You pay 20 percent of the Medicare-approved amount after you meet your Part B deductible, and the chiropractor cannot charge you more than the Medicare-approved fee.
  • Some Medicare Advantage and Medigap plans cover additional chiropractic services, so check your specific plan to see what is included.

How many chiropractic visits does Medicare cover per year

Medicare covers up to 12 visits per calendar year for spinal manipulation. This is a limit set by Medicare, not by individual chiropractors or plans. If your doctor believes you need more than 12 visits, the chiropractor can request an exception from Medicare, but Medicare must approve it before you receive additional visits.

The 12-visit limit resets on January 1 each year. If you use all 12 visits by November, you will have 12 new visits available starting January 1. Visits that do not result in spinal manipulation—such as an appointment where you only receive massage or stretching—do not count toward the 12-visit limit, but Medicare will not pay for those services anyway.

What you pay out of pocket for chiropractic care

After you meet your Part B deductible for the year, you pay 20 percent of the Medicare-approved amount for each spinal manipulation visit. The Medicare-approved amount varies by location and is set by Medicare, not by the chiropractor. In 2024, the Medicare-approved amount for a spinal manipulation visit ranges from roughly $30 to $50 depending on your region, meaning your 20 percent cost is typically $6 to $10 per visit.

The chiropractor cannot charge you more than the Medicare-approved amount. If a chiropractor tries to charge you above that amount, report it to Medicare by calling 1-800-MEDICARE or visiting Medicare.gov. You are responsible only for your 20 percent share and any remaining Part B deductible you have not yet met.

If you have a Medigap plan, it may cover some or all of your 20 percent cost-sharing. If you have a Medicare Advantage plan, your out-of-pocket costs depend on your plan's copay or coinsurance structure, which may be different from the 20 percent rule.

How Medicare decides whether to pay for your visits

The chiropractor must document that you have a vertebral subluxation and that spinal manipulation is medically necessary to treat it. "Subluxation" in Medicare's definition means a vertebra that is out of place and causing nerve interference. The chiropractor will take X-rays or other imaging to show the misalignment and will document your symptoms and the reason for treatment in your medical record.

Medicare reviews the chiropractor's documentation to decide whether to pay. If Medicare believes the documentation does not support medical necessity, it may deny the claim. If that happens, the chiropractor should tell you, and you have the right to appeal. The chiropractor can also request an exception before treatment if they believe Medicare may deny the claim based on the initial documentation.

Your primary care doctor does not need to refer you to a chiropractor for Medicare to pay, but the chiropractor's records must show that the treatment is medically necessary. If you have questions about whether your condition will be covered, ask the chiropractor to contact Medicare before your first visit.

Medicare Advantage and Medigap coverage of chiropractic care

Medicare Advantage plans (Part C) are required by law to cover at least what Original Medicare covers—spinal manipulation for subluxation. However, many Medicare Advantage plans cover additional chiropractic services such as massage, stretching, or wellness visits. Some plans cover 20 visits per year instead of 12. You will need to check your plan's coverage document or call your plan to see what chiropractic services are included.

Medigap plans do not cover chiropractic care beyond what Original Medicare covers. Medigap plans are designed to cover cost-sharing (your deductible and coinsurance), not additional services. If your Medigap plan covers chiropractic care, it is only paying your 20 percent share, not expanding what Medicare itself will pay for.

Finding a Medicare-enrolled chiropractor

You can search for Medicare-enrolled chiropractors on Medicare.gov using the "Care Provider Search" tool. Enter your zip code and select "Chiropractor" as the provider type. The search will show you chiropractors in your area who are enrolled in Medicare.

When you call a chiropractor's office, confirm three things: that they are enrolled in Medicare, that they accept Medicare patients, and that they will submit claims to Medicare on your behalf (this is called "accepting assignment"). If a chiropractor does not accept assignment, you may have to pay the full cost upfront and then request reimbursement from Medicare yourself, which takes longer.

Ask the office whether they have treated your condition before and whether they believe your condition will meet Medicare's medical necessity standard. A chiropractor familiar with Medicare's rules can tell you upfront whether your case is likely to be covered.

What to do if Medicare denies your chiropractic claim

If Medicare denies a claim for chiropractic care, you will receive a notice called a "Explanation of Benefits" (EOB) that explains why. Common reasons for denial include: the documentation did not show a subluxation, the visit was not medically necessary, you exceeded the 12-visit limit, or the chiropractor is not enrolled in Medicare.

You have the right to appeal any denial. The appeal process has multiple levels: you can ask the chiropractor to resubmit with better documentation, request a review by Medicare, or ask for a hearing before an administrative law judge. The EOB will tell you how to appeal and the important date for doing so. If you need help understanding the denial or filing an appeal, you can contact your State Health Insurance information Program (SHIP), which offers free counseling.

Frequently Asked Questions

Can I see a chiropractor without a referral from my doctor?

Yes. Medicare does not require a referral from your primary care doctor to see a chiropractor. You can contact a Medicare-enrolled chiropractor directly and schedule an appointment. However, the chiropractor must still document that the treatment is medically necessary for Medicare to pay.

Does Medicare cover chiropractic X-rays?

No. Medicare does not cover X-rays or other imaging ordered by a chiropractor, even if the X-rays are used to diagnose a subluxation. If you need imaging, your primary care doctor can order it, and Medicare will cover it under the usual imaging rules.

What if my chiropractor says I need 20 visits but Medicare only covers 12?

Your chiropractor can request an exception from Medicare if they believe more than 12 visits are medically necessary. Medicare will review the request and decide whether to approve additional visits. You should not pay out of pocket for visits beyond the 12-visit limit unless Medicare has approved them in advance.

Will my Medicare Advantage plan cover more chiropractic visits than Original Medicare?

It may. Some Medicare Advantage plans cover more than 12 visits per year or cover additional chiropractic services like massage. Check your plan's coverage document or call your plan's customer service to find out what chiropractic services are included in your specific plan.

What happens if a chiropractor charges me more than Medicare allows?

A Medicare-enrolled chiropractor who accepts assignment cannot charge you more than the Medicare-approved amount. If one does, report it to Medicare at 1-800-MEDICARE. You should only pay your 20 percent share plus any remaining deductible.