Medicare covers some chiropractic visits, but only for one specific condition and only under strict limits

Medicare Part B covers chiropractic care, but the coverage is narrow. Medicare will pay for chiropractic treatment only when a doctor has diagnosed you with subluxation of the spine — a misalignment of the vertebrae that is causing you pain or limiting your movement. Even then, Medicare covers only the manipulation itself, not X-rays, other imaging, or other services a chiropractor might offer.

The visit must be ordered by your primary care doctor or another physician, and the chiropractor must be Medicare-enrolled. You pay 20 percent of the Medicare-approved amount 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 doctor must document that the treatment is medically necessary.

Key Takeaways

  • Medicare covers spinal manipulation only when a doctor has diagnosed subluxation of the spine and referred you to a Medicare-enrolled chiropractor.
  • You must have a physician's order before the visit; Medicare will not cover chiropractic care you seek on your own.
  • Medicare pays for the manipulation itself but not for X-rays, MRI scans, or other diagnostic or therapeutic services the chiropractor performs.
  • You pay 20 percent of the Medicare-approved amount after meeting your Part B deductible, and there is no visit limit if your doctor documents medical necessity.

What Medicare will and will not pay for

Medicare covers the actual spinal manipulation — the hands-on adjustment of the spine. This is the core service a chiropractor provides. The chiropractor must perform the manipulation in person; telehealth chiropractic visits are not covered.

Medicare does not cover any other services at a chiropractic office. This includes X-rays or other imaging ordered by the chiropractor, massage therapy, heat or ice therapy, ultrasound, electrical stimulation, or any other modality. If the chiropractor orders imaging, you will pay out of pocket or the chiropractor may bill you directly. Some chiropractic offices will not perform these services if they know Medicare is the primary payer, because they cannot bill Medicare for them.

Medicare also does not cover chiropractic care for conditions other than subluxation of the spine. If you have back pain from a herniated disc, arthritis, or muscle strain, Medicare will not cover chiropractic treatment for those conditions, even if your doctor thinks it might help.

How to make sure your visit is covered

Before you schedule a chiropractic appointment, you need a written order from your doctor. Call your primary care doctor or the doctor who diagnosed your back problem and ask for a referral to a chiropractor for spinal manipulation. The doctor will need to document that you have subluxation of the spine and that manipulation is medically necessary. Without this order, Medicare will not cover the visit.

Once you have the order, call the chiropractic office and confirm that they are enrolled with Medicare. You can search for Medicare-enrolled chiropractors on the Medicare provider search tool at Medicare.gov. When you call, also ask the office what they charge and what your out-of-pocket cost will be. Some offices will give you an estimate based on your deductible status.

Bring your Medicare card and the doctor's order to your first appointment. The chiropractor's office will verify your coverage and tell you what you owe. If the office is not enrolled with Medicare, they cannot bill Medicare directly, and you will have to pay the full cost upfront and then submit a claim yourself — a process that is slow and often unsuccessful.

What you will pay out of pocket

You pay 20 percent of the Medicare-approved amount for each visit after you have met your Part B deductible. The Medicare-approved amount is not the same as what the chiropractor charges; it is the amount Medicare has decided is reasonable for that service in your area. If the chiropractor charges more than the Medicare-approved amount, you do not pay the difference — that is called balance billing, and Medicare-enrolled providers are not allowed to do it.

The exact cost depends on your deductible status. If you have not yet met your Part B deductible for the year, you will pay the full cost of the first few visits until you reach the deductible amount, and then you will pay 20 percent of the approved amount for visits after that. If you have already met your deductible, you pay 20 percent of the approved amount for each visit from the start.

If you have a Medigap or Medicare Advantage plan, your out-of-pocket cost may be lower. Medigap plans often cover the 20 percent coinsurance. Medicare Advantage plans vary; some cover chiropractic care and some do not. Check your plan documents or call your plan to find out.

When Medicare will not cover a chiropractor visit

Medicare will not cover a visit if you do not have a doctor's order. Even if you have seen a chiropractor before and have a history of back problems, you need a current order from a physician for each course of treatment. If you go to a chiropractor without an order, you will be responsible for the full cost.

Medicare will not cover a visit if the chiropractor is not enrolled with Medicare. Some chiropractors choose not to enroll because of the paperwork or because they prefer to set their own fees. If you see a non-enrolled chiropractor, Medicare will not reimburse you, even if you submit a claim yourself.

Medicare will not cover a visit if the diagnosis is not subluxation of the spine. If your doctor diagnoses you with a herniated disc, sciatica, or general back pain, chiropractic manipulation is not covered, even if your doctor thinks it might help. In these cases, you would need to pay out of pocket or explore other treatment options that Medicare does cover, such as physical therapy.

Chiropractic care under Medicare Advantage plans

Medicare Advantage plans (Part C) are run by private insurance companies and can cover services differently than Original Medicare does. Some Medicare Advantage plans cover chiropractic care more broadly than Original Medicare — for example, they may cover visits without a doctor's order, or they may cover additional services like X-rays. Other plans do not cover chiropractic care at all.

If you are enrolled in a Medicare Advantage plan, check your plan documents or call the plan's customer service line to find out what chiropractic services are covered and what you will pay. The coverage rules are different from Original Medicare, so do not assume that what is covered under Original Medicare is covered under your plan.

Questions to ask your doctor

If you are considering chiropractic care for back pain, ask your doctor these questions before you schedule an appointment:

  • Do I have subluxation of the spine, or is my back pain from another cause?
  • Do you think spinal manipulation would help my condition?
  • Will you write a referral to a chiropractor, and will you document that the treatment is medically necessary?
  • How many visits do you think I will need?
  • Are there other treatments — such as physical therapy or medication — that might help instead of or in addition to chiropractic care?

Frequently Asked Questions

Can I see a chiropractor without a doctor's referral and have Medicare pay?

No. Medicare requires a physician's order before covering chiropractic care. You can see a chiropractor without a referral, but you will pay the full cost yourself. If you want Medicare to cover the visit, you must first see your doctor and ask for a referral.

Does Medicare cover chiropractic X-rays?

No. Medicare covers only the spinal manipulation itself. If the chiropractor orders X-rays or other imaging, you will pay for those services out of pocket. Some chiropractors will not order imaging if they know Medicare is the primary payer.

How many chiropractic visits will Medicare cover?

There is no set limit. Medicare will cover as many visits as your doctor documents as medically necessary. However, your doctor must order the treatment and the chiropractor must be enrolled with Medicare. If either of these conditions is not met, Medicare will not cover any visits.

What if my chiropractor charges more than Medicare allows?

If the chiropractor is enrolled with Medicare, they cannot charge you more than the Medicare-approved amount plus your 20 percent coinsurance. If they do, that is balance billing, which is illegal. If a Medicare-enrolled chiropractor tries to balance bill you, report it to Medicare at 1-800-MEDICARE.

Does my Medicare Advantage plan cover chiropractic care the same way?

No. Medicare Advantage plans set their own coverage rules. Some plans cover chiropractic care more broadly than Original Medicare, and some do not cover it at all. Check your plan documents or call your plan to find out what is covered under your specific plan.