Medicare's coverage of chiropractic care is limited to spinal manipulation for acute lower back pain

Medicare Part B covers chiropractic services, but only under specific conditions. A chiropractor must perform spinal manipulation — the adjustment of vertebrae in your spine — to treat acute lower back pain. Acute means the pain is new or has lasted fewer than 12 weeks. Medicare will not pay for chiropractic care for any other condition, including neck pain, headaches, or chronic back pain lasting longer than 12 weeks.

The chiropractor must also document that your lower back pain is caused by a condition that limits your movement or function. You will need a referral from your primary care doctor or another physician before your first visit. Without this referral, Medicare will not cover the cost.

Medicare covers up to 30 visits per year for spinal manipulation, though your doctor may recommend fewer. You pay 20 percent of the Medicare-approved amount after you have met your Part B deductible for the year. The chiropractor must be enrolled in Medicare and accept Medicare assignment (meaning they agree to the Medicare fee).

Key Takeaways

  • Medicare Part B covers spinal manipulation only for acute lower back pain that started recently and limits your movement.
  • You must have a referral from your doctor before your first chiropractic visit for Medicare to pay.
  • Medicare covers up to 30 visits per year, and you pay 20 percent of the approved cost after your deductible.
  • Other chiropractic services — X-rays, massage, stretching, or treatment for neck pain — are not covered by Medicare.
  • The chiropractor must be enrolled in Medicare and accept Medicare's approved fee.

What conditions Medicare will and will not cover

Medicare covers spinal manipulation only when a doctor has diagnosed you with acute lower back pain caused by a condition that restricts your movement or function. Common conditions that may meet this standard include acute muscle strain, a pinched nerve, or a subluxation (a vertebra that has moved out of alignment). The pain must be new — it cannot have been present for more than 12 weeks before your first chiropractic visit.

Medicare does not cover chiropractic care for chronic back pain (pain lasting longer than 12 weeks), neck pain, headaches, fibromyalgia, or any condition other than acute lower back pain. Medicare also does not cover other services a chiropractor may offer, such as X-rays, ultrasound, massage therapy, stretching exercises, or nutritional counseling — even if the chiropractor performs these services during your visit.

How to get a referral from your doctor

Before you schedule a chiropractic appointment, contact your primary care doctor or the doctor treating your lower back pain. Tell them you have acute lower back pain and ask whether they believe spinal manipulation would help. If your doctor agrees, ask them to write a referral for chiropractic care. The referral should state that you have acute lower back pain and that the doctor believes spinal manipulation is medically necessary.

Your doctor does not need to refer you to a specific chiropractor — you can choose any Medicare-enrolled chiropractor. However, some doctors may have a preferred chiropractor or may want to know which one you plan to see. Bring the referral with you to your first appointment. The chiropractor's office will verify that your referral is on file with Medicare before your visit.

Finding a Medicare-enrolled chiropractor

Not all chiropractors accept Medicare. To find one who does, use the Medicare Provider Search tool on Medicare.gov. 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 to schedule an appointment, confirm that the chiropractor accepts Medicare assignment. This means they have agreed to accept Medicare's approved fee as full payment (except for your 20 percent coinsurance). If a chiropractor does not accept assignment, you may have to pay the full cost upfront and seek reimbursement yourself, which is more complicated.

Ask the chiropractor's office whether they will need your referral before your first visit or whether you can bring it with you. Some offices ask you to have your doctor send the referral directly to them.

What you will pay out of pocket

You pay 20 percent of the Medicare-approved amount for each chiropractic visit after you have met your Part B deductible. The deductible is the amount you must pay out of your own pocket before Medicare begins to pay its share. The Part B deductible is the same whether you see a chiropractor, doctor, or other provider.

The actual cost depends on the Medicare-approved fee in your area, which varies by location. You can ask the chiropractor's office what the Medicare-approved fee is for a spinal manipulation visit in your area, and they can tell you what your 20 percent coinsurance will be. If you have a Medigap or Medicare Advantage plan, your out-of-pocket cost may be lower, depending on your plan's coverage.

Medicare Advantage plans and chiropractic care

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 under the same rules as Original Medicare (acute lower back pain with a referral, up to 30 visits per year). Other plans may cover more visits, fewer visits, or may not cover chiropractic care at all.

Check your Medicare Advantage plan's summary of benefits or call the plan directly to learn what chiropractic services are covered. You will still need a referral from your doctor, and you will still pay a coinsurance or copay for each visit. The amount you pay may be different from what you would pay under Original Medicare.

When to ask your doctor about chiropractic care

If you have acute lower back pain that started recently and limits your ability to move or work, ask your doctor whether spinal manipulation might help. Your doctor can assess whether your pain is caused by a condition that responds to chiropractic care and whether it is safe for you to receive spinal manipulation.

Some conditions — such as severe osteoporosis, spinal cord compression, or certain types of arthritis — may make spinal manipulation unsafe. Your doctor will know your medical history and can advise you. If your doctor believes chiropractic care is not appropriate for you, ask what other treatments might help your back pain.

Frequently Asked Questions

Does Medicare cover chiropractic care for neck pain?

No. Medicare covers spinal manipulation only for acute lower back pain. Neck pain, even if it is new and limits your movement, is not covered by Medicare. If you have neck pain, ask your doctor about other treatment options that Medicare may cover, such as physical therapy or pain management.

What if my back pain has lasted longer than 12 weeks?

Medicare does not cover chiropractic care for chronic back pain. If your pain has lasted more than 12 weeks, you will have to pay for chiropractic visits out of your own pocket. Talk to your doctor about other treatments for chronic pain, such as physical therapy, exercise, or medication, which may be covered by Medicare.

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

No. Medicare requires a referral from a physician before your first chiropractic visit. Without a referral, Medicare will not pay for the visit, and you will have to pay the full cost yourself. Contact your doctor before you schedule an appointment.

Do I have to use the chiropractor my doctor recommends?

No. Your doctor's referral does not tie you to a specific chiropractor. You can choose any Medicare-enrolled chiropractor. However, confirm with the chiropractor's office that they accept Medicare assignment before your first visit.

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

Some Medicare Advantage plans do cover more than 30 visits per year, and some cover fewer. A few plans do not cover chiropractic care at all. Check your plan's summary of benefits or call the plan to find out what is covered under your specific plan.