What Medicare Part B Covers for Chiropractic Care

Medicare Part B covers some chiropractic services, but only for one specific condition and only when ordered by a doctor

Medicare Part B will pay for chiropractic care, but the coverage is narrow. Part B covers spinal manipulation — the adjustment of the spine — only when a doctor has diagnosed you with subluxation of the spine (a misalignment that is causing you pain or limiting movement). The chiropractor must have a referral or order from your doctor, and Medicare will pay 80 percent of the approved amount after you have met your Part B deductible.

Medicare does not cover other services a chiropractor might offer, such as X-rays, massage, ultrasound, or other therapies — even if the same chiropractor performs them. If your chiropractor orders an X-ray, that X-ray is not covered under the chiropractic benefit. You would need to pay for it yourself or see if it is covered under a different part of your Medicare plan.

Not every chiropractor accepts Medicare. You will need to confirm that your chiropractor is enrolled in Medicare and willing to treat Medicare patients before you schedule an appointment.

Key Takeaways

Medicare Part B covers spinal manipulation only when a doctor has ordered it for subluxation of the spine.
You must have a doctor's referral or order before the chiropractor can bill Medicare for the visit.
Medicare pays 80 percent of the approved amount after your deductible is met; you pay the remaining 20 percent.
Services like X-rays, massage, and other therapies performed by the chiropractor are not covered by Medicare Part B.
Not all chiropractors accept Medicare, so confirm enrollment and acceptance before scheduling.

How to get a doctor's referral for chiropractic care

Start by talking to your primary care doctor or the doctor treating you for back or neck pain. Tell them you are experiencing pain or limited movement in your spine and ask whether they think spinal manipulation might help. If your doctor agrees that subluxation of the spine is the problem, they can write an order or referral for chiropractic treatment.

Your doctor's order should state that you have subluxation of the spine and that spinal manipulation is medically necessary. The chiropractor will need this documentation to submit a claim to Medicare. Some doctors will fax or email the order directly to the chiropractor's office; others will give you a copy to bring yourself.

If your doctor is unsure whether chiropractic care is right for you, ask for a referral to a spine specialist or physiatrist (a doctor who specializes in physical medicine and rehabilitation). That doctor can also provide the order Medicare requires.

Finding a Medicare-enrolled chiropractor

Use the Medicare Provider Search tool on Medicare.gov to find chiropractors in your area who accept Medicare. Go to Medicare.gov, click "Care Providers," and search by your zip code and the type of provider (chiropractor). The search results will show you which chiropractors are enrolled in Medicare.

Call the chiropractor's office directly and confirm two things: that they are currently accepting Medicare patients, and that they will accept Medicare assignment (meaning they will bill Medicare directly and you will only pay your share of the approved amount). If a chiropractor does not accept assignment, you may have to pay the full bill upfront and then submit a claim to Medicare yourself, which takes longer.

Ask the office staff how many visits Medicare typically covers for subluxation treatment. While Medicare does not set a hard limit on the number of visits, the chiropractor's office will have experience with what Medicare reviewers usually approve.

What you will pay out of pocket

Your out-of-pocket cost depends on whether you have met your Part B deductible for the year. For 2024, the Part B deductible is $240 (this amount may change each year). Once you have paid $240 in Part B services, your deductible is met for the rest of the year.

After your deductible is met, Medicare pays 80 percent of the approved amount for spinal manipulation, and you pay 20 percent. The "approved amount" is what Medicare decides the service is worth — not necessarily what the chiropractor charges. If the chiropractor accepts assignment, they cannot bill you more than your 20 percent share.

If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower. Medigap plans can cover part or all of your 20 percent coinsurance. Medicare Advantage plans have their own rules about chiropractic coverage, so check your plan documents or call the plan to confirm what you will pay.

When Medicare will not cover chiropractic care

Medicare will not pay for chiropractic visits without a doctor's order. If you go to a chiropractor on your own without a referral, you will have to pay the full cost yourself. Medicare also will not cover visits if the chiropractor diagnoses you with a condition other than subluxation of the spine, or if your doctor did not order the treatment.

Medicare will not cover any services beyond spinal manipulation, even if the chiropractor performs them. This includes X-rays taken at the chiropractor's office, ultrasound, massage therapy, heat therapy, or exercises. If your chiropractor recommends these services, you will pay for them separately, or they may be covered under a different part of your Medicare plan (for example, physical therapy ordered by your doctor may be covered under Part B).

If your chiropractor orders imaging like an X-ray or MRI, that imaging is not covered as part of the chiropractic benefit. Your doctor would need to order the imaging separately for it to have any chance of Medicare coverage.

Chiropractic care under Medicare Advantage plans

If you have a Medicare Advantage plan (Part C) instead of Original Medicare, your coverage for chiropractic care may be different. Some Medicare Advantage plans cover spinal manipulation with the same rules as Original Medicare (doctor's order, subluxation diagnosis). Other plans cover additional chiropractic services or do not require a doctor's order. A few plans do not cover chiropractic care at all.

Check your Medicare Advantage plan's Summary of Benefits or call the plan directly to find out what chiropractic services are covered, what your copay or coinsurance will be, and whether you need a referral. The rules vary widely from plan to plan, so do not assume your coverage is the same as a friend's plan.

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). The EOB will explain why the claim was denied — for example, "no doctor's order on file" or "diagnosis does not meet coverage criteria."

If you believe the denial is wrong, you can file an appeal. You have 120 days from the date on the EOB to request a reconsideration. Contact your chiropractor's office and ask them to help you gather the documents you need, such as your doctor's order and medical records showing your diagnosis. You can submit the appeal yourself or ask the chiropractor's office to submit it on your behalf.

If the appeal is denied again, you have the right to request a hearing before a Medicare contractor. The process takes time, but many people succeed on appeal when they can show that a doctor did order the treatment and that subluxation was documented.

Frequently Asked Questions

Do I need a referral every time I see the chiropractor, or just once?

You need a doctor's order before treatment begins, but you typically do not need a new order for each visit. One order from your doctor can cover a course of treatment — usually several visits over a few weeks or months. If your treatment goes on for a long time, your doctor may need to provide an updated order to show that the treatment is still medically necessary.

Can my chiropractor bill Medicare if I do not have a doctor's order yet?

No. If you see a chiropractor without a doctor's order, Medicare will not pay, and you will be responsible for the full bill. Always get your doctor's order before your first appointment. If you have already paid out of pocket, you can ask your doctor for a retroactive order and submit an appeal, but this is more complicated than getting the order first.

What if my doctor says chiropractic care is not necessary?

If your doctor does not think spinal manipulation will help your condition, they will not write an order. You can ask for a second opinion from another doctor, such as a spine specialist. If that doctor agrees that chiropractic care is medically necessary, they can provide the order Medicare requires.

Does Medicare cover chiropractic care for prevention or wellness?

No. Medicare only covers spinal manipulation when it is ordered by a doctor to treat a diagnosed condition (subluxation of the spine). Visits for general wellness, prevention, or maintenance are not covered, even if you have a doctor's order.

If I have both Medicare and Medicaid, which one pays for chiropractic care?

Medicare is your primary payer, so Medicare will be billed first. Medicaid may cover some chiropractic services that Medicare does not, but rules vary by state. Contact your state Medicaid office to learn what chiropractic services Medicaid covers in your state.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.