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 vertebra that has moved out of its normal position. Medicare will not pay for other chiropractic treatments, diagnostic imaging ordered by a chiropractor, or visits for general wellness or pain management that do not involve a documented subluxation.
The chiropractor must be licensed in the state where they practice and must document the subluxation with X-rays or other imaging before treatment begins. Medicare requires this documentation before it will consider paying any claim. Without it, the claim will be denied, and you will owe the full cost.
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 the chiropractor cannot bill Medicare for services that do not meet these requirements.
Key Takeaways
- Medicare Part B covers spinal manipulation only when a chiropractor documents a subluxation with imaging before treatment starts.
- Medicare does not cover chiropractic adjustments for general pain, wellness visits, or any other chiropractic service besides manipulation for subluxation.
- You pay 20 percent of the Medicare-approved amount per visit after meeting your Part B deductible, with no visit limit.
- The chiropractor must be state-licensed and must submit the subluxation documentation to Medicare before billing you.
What Subluxation Means and How Medicare Defines It
Medicare's definition of subluxation is narrower than what many chiropractors use in their own practice. Medicare defines it as a vertebra that is out of alignment and can be seen on X-ray or other imaging. The misalignment must be causing a neuromusculoskeletal condition — meaning it affects nerves, muscles, or the skeleton — and the condition must be treatable by spinal manipulation.
The chiropractor must order imaging before the first treatment visit and must include the images and a written report with the Medicare claim. If Medicare reviewers cannot see the subluxation on the imaging, or if the documentation does not show that manipulation will treat it, Medicare will deny the claim. This happens often, so ask the chiropractor upfront whether they believe your condition meets Medicare's definition and whether they have submitted similar cases to Medicare before.
How to Know If Your Chiropractor Accepts Medicare
Not all chiropractors accept Medicare, and some accept it only for certain patients or conditions. Before your first visit, call the chiropractor's office and ask directly: "Do you accept Medicare?" and "Will you submit the claim to Medicare, or will I need to pay upfront and file for reimbursement myself?"
Some chiropractors are "participating providers," meaning they have a contract with Medicare and agree to accept Medicare's approved amount as payment in full. Others are "non-participating," meaning they can charge more than Medicare's approved amount, and you may owe the difference. A few chiropractors do not accept Medicare at all and will ask you to pay the full cost out of pocket.
You can search for participating chiropractors in your area using the Medicare Provider Search tool on Medicare.gov. Enter your zip code and select "Chiropractor" as the provider type. The search will show you which chiropractors in your area accept Medicare.
The Documentation and Approval Process
The chiropractor must obtain imaging — usually X-rays — before your first treatment visit. They will then write a report describing the subluxation, how it was found, and why spinal manipulation will treat it. This report and the images must be sent to Medicare before the chiropractor can bill for any visits.
Medicare will review the documentation and send a decision to the chiropractor. If Medicare approves it, the chiropractor can proceed with treatment and bill Medicare for each visit. If Medicare denies it, the chiropractor should tell you in writing before treating you further. At that point, you can choose to pay out of pocket or stop treatment.
This process usually takes one to two weeks. Ask the chiropractor when they expect to hear back from Medicare before you schedule your first treatment visit. Do not assume approval has been granted just because the chiropractor has seen you — Medicare's decision comes separately.
What You Pay Out of Pocket
Once Medicare approves your subluxation documentation, you are responsible for 20 percent of the Medicare-approved amount for each visit. The Medicare-approved amount varies by location and is set by Medicare each year, not by the chiropractor.
If your chiropractor is a participating provider, they cannot charge you more than 20 percent of the approved amount. If they are non-participating, they can charge up to 15 percent more than the approved amount, and you would owe that difference on top of the 20 percent coinsurance.
You must also meet your Part B deductible before Medicare begins to pay its share. For 2024, the Part B deductible is $240, but this amount changes each year. Once you have paid $240 out of pocket for Part B services, Medicare pays 80 percent and you pay 20 percent for the rest of the year.
Services Medicare Does Not Cover
Medicare does not cover chiropractic X-rays, MRIs, or other imaging ordered by a chiropractor, even if the imaging is used to document a subluxation. You will need to pay for imaging out of pocket or have it done by another provider whose imaging Medicare will cover.
Medicare also does not cover massage therapy, ultrasound, heat therapy, or other treatments a chiropractor may offer alongside spinal manipulation. If a chiropractor bills Medicare for these services, the claim will be denied. Some chiropractors may ask you to pay for these services separately, outside of Medicare.
Wellness visits, preventive care, and treatment for general back pain without a documented subluxation are not covered. If you want chiropractic care for these reasons, you will pay the full cost out of pocket.
What to Do If Medicare Denies Your Claim
If Medicare denies your subluxation documentation, the chiropractor should send you a notice explaining why. Common reasons include: the imaging does not clearly show a subluxation, the subluxation is not in a location Medicare covers, or the documentation does not show that manipulation will treat the condition.
You have the right to ask Medicare to review its decision. This is called an appeal. The chiropractor can help you file an appeal by submitting additional documentation or a written explanation. You can also contact Medicare directly at 1-800-MEDICARE to ask about the denial and learn how to appeal.
If you disagree with the appeal decision, you can request a hearing before a Medicare administrative law judge. This process takes longer but gives you a chance to present your case in more detail. Ask the chiropractor or your doctor whether they think an appeal is worth pursuing in your situation.
Frequently Asked Questions
Does Medicare cover chiropractic care for neck pain or lower back pain?
Medicare covers spinal manipulation for neck or lower back pain only if a chiropractor documents a subluxation with imaging before treatment. Pain alone is not enough. The subluxation must be visible on X-ray or other imaging, and the documentation must show that manipulation will treat it.
Can I see a chiropractor without a referral from my doctor?
No referral is required to see a chiropractor, but Medicare requires that the chiropractor document a subluxation before billing. Some chiropractors ask patients to see their primary care doctor first to rule out other causes of pain. This is not a Medicare requirement, but it may help if Medicare denies the claim.
What if my chiropractor says Medicare will not cover my condition?
If a chiropractor tells you upfront that your condition does not meet Medicare's definition of subluxation, they should not bill Medicare or ask you to pay and file for reimbursement yourself. Ask them to explain in writing why they believe Medicare will not cover it. You can then contact Medicare at 1-800-MEDICARE to ask whether your condition might be covered.
Will Medicare cover chiropractic care if I have a Medigap or Medicare Advantage plan?
Original Medicare (Part A and Part B) covers spinal manipulation for subluxation as described here. If you have a Medigap plan, it may cover some or all of your 20 percent coinsurance. If you have a Medicare Advantage plan, coverage rules may differ — contact your plan to ask what chiropractic services it covers.
Can I use my Medicare benefits to pay for chiropractic care at a wellness center or spa?
No. Medicare covers only chiropractic spinal manipulation for subluxation performed by a licensed chiropractor. Wellness centers, spas, and other facilities that offer chiropractic services may not be enrolled with Medicare, and their services would not be covered even if they were.