What Chiropractic Care Does Medicare Cover?

Jan 06, 2023 By Susan Kelly

If it is determined to be medically necessary to rectify a subluxation by manual adjustment of spine by chiropractor or another qualified physician, Medicare Part B will reimburse the cost of the treatment. When one or more of the bones in your spine shift slightly out of alignment, this condition is known as a subluxation. (In addition, you are required to obtain a formal diagnosis.)

X-rays, massage treatment, and acupuncture are just some therapies that Medicare does not pay for when prescribed by a chiropractor (except for chronic low back pain).

What Will Chiropractic Care Cost Under Medicare?

Because chiropractic treatments are covered under Medicare Part B, you will be responsible for paying 20% of the Medicare-approved amount in addition to the Part B deductible if one is required. Your particular expenses will be determined, among other things, by the fee that the physician charges, the kind of facility you use, and the location of the location where you get the services.

Do Chiropractic Treatments Get Covered By Medicare Advantage?

Medicare Part C plans, commonly known as Medicare Advantage plans, are required by law to offer at least the same level of coverage as Original Medicare (Parts A and B), as detailed above. You should verify with your Medicare Advantage plan whether they cover additional chiropractic services. Massage therapy and acupuncture are alternative treatments that Medicare Advantage plans may cover. Is there anything you need to know about your Medicare plan? Medicare may be contacted at 800-MEDICARE or Medicare.gov (800-633-4227, TTY: 877-486-2048).

What Chiropractic Treatments Are Not Covered By Medicare?

There is no limit on the number of chiropractic visits that Medicare covers; however, the spinal manipulation required to repair the subluxation can only be paid for if it is medically necessary. Insurance will not pay for chiropractic appointments routinely scheduled for maintenance or prevention, nor will it cover chiropractic care for other areas of the body.

Medicare will only pay for an X-ray ordered by a medical doctor if it is necessary to confirm that a spinal subluxation needs therapy. Medicare will not cover the expense of any X-ray that a chiropractor has ordered. This is a significant distinction, so keep it in mind. Medicare will not pay for X-rays, or other diagnostic tests ordered, performed, or interpreted by a chiropractor. This includes any of the three scenarios listed above.

In addition, Medicare does not pay for any treatments or tests prescribed by a chiropractor, such as a massage therapy or acupuncture, unless the acupuncture is intended to treat persistent low back pain.

Do Chiropractic Treatments Get Covered By Medicare Advantage?

You could be eligible for additional coverage for chiropractic treatments. Medicare Advantage plans are required to cover at least the same chiropractic treatments as the old Medicare program, but they are free to set copayments and deductibles.

Be aware that you may be responsible for a copayment of up to $30 or $20 for each chiropractic appointment. In addition, the Medicare Advantage plan can demand that you see a doctor who is part of the plan's network.

As an added perk, certain Medicare Advantage plans may pay for chiropractic adjustments during regular checkups. Use the Medicare Plan Finder to get a list of available plans in your region and to see whether those policies cover additional chiropractic treatments.

Click the Plan Details button inside each of the results, then scroll down until you reach the dark blue bar and click the + View additional benefits & costs button. Continue scrolling down until you see the + View additional extra advantages option.

You will find chiropractic services on the list of non-opioid pain treatment options authorized by the medical community. The box will either state that there is some coverage or no coverage. You will need to get in touch with the plan or go to their website for more information.

Conditions a Chiropractor Can Treat

According to the American Chiropractic Association, an estimated 35 million individuals see a chiropractor in the United States each year. Alternative therapy options for pain and suffering include chiropractic care as an alternative to surgical procedures and pain medicines. The following are some examples of problems that a chiropractor may treat:

  • Back pain
  • Headaches
  • Neck pain

In addition to these treatments, a chiropractor could also provide wellness services, including food, exercise, and nutrition interventions.

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