If you want to know whether Medicare helps pay for chiropractic care, the short answer is: Medicare Part B covers spinal manipulation only when a doctor or chiropractor finds a vertebral subluxation that is medically necessary.
You can get some coverage for spinal adjustments, but most other chiropractic therapies usually aren’t paid for by Original Medicare.
You’ll learn what counts as eligible care, what Medicare won’t cover, and how to actually get services approved and billed.
The Modern Medicare Agency connects you with licensed agents who talk with you one-on-one, find Medicare plans that match your needs, and explain costs without hidden fees.
Keep reading to see which services qualify, how claims work, what Medicare Advantage plans may add, and where to find up-to-date rules and help from experts.
Eligibility Criteria for Chiropractic Medicare Coverage
Medicare covers chiropractic services only when specific medical rules are met.
You need to meet Part B rules, provide the right documentation, and be in one of the beneficiary groups that Medicare recognizes.
Medicare Part B Requirements
Medicare Part B covers manual manipulation of the spine to correct a subluxation that a doctor documents.
You must have a neuromusculoskeletal condition that a licensed chiropractor or other physician finds requires treatment.
Medicare will not cover X-rays, massage, or other services as part of chiropractic care unless those services are medically necessary and billed under a covered benefit.
You must receive services from a practitioner who accepts Medicare assignment or from a provider in a Medicare-approved setting.
Part B may require you to meet deductible and coinsurance rules, so expect to pay 20% of the Medicare-approved amount after the Part B deductible is met.
If you have Medicare Advantage, coverage rules and out-of-pocket costs can differ from Original Medicare.
Documentation Needed for Coverage
Your chiropractor or treating physician must document the subluxation and the medical necessity of manipulation in your medical record.
Records should include a clear diagnosis, the clinical findings that support subluxation, treatment plans, and progress notes showing improvement or continuing need.
Without these notes, Medicare may deny payment.
Keep copies of all visit notes, referrals, and test results.
If you submit claims or appeal denials, well-organized records make the process faster.
The Modern Medicare Agency can help you understand what documentation your plan requires and assist with questions when a claim looks at risk of denial.
Types of Beneficiaries Covered
Original Medicare Part B covers eligible beneficiaries who are enrolled in Part B and meet medical necessity rules.
Beneficiaries in Medicare Advantage (Part C) may also get chiropractic coverage, but benefits, copays, and limits can vary by plan.
You must check your specific plan for limits on visits and any prior authorization rules.
If you have supplemental Medigap coverage, it may help pay some Part B coinsurance for covered chiropractic services.
Active-duty veterans or those in special programs should verify primary coverage rules, as Medicare coordination of benefits can change who pays first.
The Modern Medicare Agency’s licensed agents can review your situation and match you with Medicare plans that fit your chiropractic care needs without extra fees.
Covered Chiropractic Services Under Medicare
Medicare covers certain spine-related services when they meet medical rules.
You should know exactly which spinal manipulation is covered, what counts as medically necessary, and how often Medicare will pay.
Spinal Manipulation Benefits
Medicare Part B covers manual manipulation of the spine when a licensed chiropractor or other qualified provider treats a subluxation (a partial dislocation or misalignment shown in the medical record).
This means you can get hands-on adjustment only when the provider documents that the spinal alignment issue is present and causing symptoms or loss of function.
Covered spinal manipulation includes the actual manual adjustment itself.
Medicare will pay for the manipulative treatment visit, but not for X-rays, massage, or other non-manual therapies unless those services meet separate Medicare rules.
You must get care from a provider who accepts Medicare, or you may face higher out-of-pocket costs.
Medically Necessary Treatments
Medicare pays only for services it calls “medically necessary.”
That means the treatment must diagnose or treat a medical condition and be reasonable and customary for that condition.
Your chiropractor must document the diagnosis, symptoms, and why the chosen treatment is needed.
Services like soft-tissue therapy, acupuncture, or ongoing maintenance care generally won’t be covered unless the chart shows active, worsening symptoms and measurable benefit.
If you use a Medicare Advantage plan, check your plan’s rules—some plans may cover extra services beyond Original Medicare.
Frequency and Duration of Coverage
Medicare does not set a fixed number of covered chiropractic visits per year.
Coverage depends on medical need shown in your records.
Each visit must include documentation that the manipulative treatment remains necessary and is helping your condition.
Expect audits or reviews when treatment is frequent or long-term.
If Medicare agrees the treatment is effective, it may continue paying.
Always keep clear records, get prior authorizations if required by your plan, and verify provider billing to avoid surprise charges.
Limitations and Exclusions of Medicare Coverage
Medicare covers only specific spinal manipulations and leaves many chiropractic services unpaid.
You may face denials for therapies, tests, or ongoing care that Medicare calls non-covered, and you will likely pay deductibles and coinsurance for covered visits.
Non-Covered Chiropractic Services
Medicare limits coverage to manual manipulation of the spine to correct a diagnosed subluxation.
Anything beyond that — such as X-rays ordered by a chiropractor, massage, acupuncture, nutritional counseling, or rehabilitative exercises provided by the chiropractor — is generally not covered.
Tests or treatments that Medicare deems not medically necessary will be denied.
If a chiropractor orders services that Medicare doesn’t cover, you become responsible for the full bill unless you signed an Advance Beneficiary Notice (ABN) before treatment.
Keep clear records: diagnoses, treatment notes, and specific manipulations help if you need to appeal a denial.
Out-of-Pocket Costs and Deductibles
Original Medicare Part B pays 80% of approved chiropractic manipulation costs after you meet the Part B deductible.
You pay the remaining 20% coinsurance and any charges for non-covered services in full.
Part A does not cover outpatient chiropractic care.
If you have a Medicare Advantage plan, cost-sharing can differ.
Some plans offer additional coverage but may require copays, prior authorization, or network restrictions.
Speaking with an agent from The Modern Medicare Agency helps you compare plans and estimate your likely out-of-pocket costs.
How to Access Chiropractic Care with Medicare
You can find a Medicare-approved chiropractor and learn what paperwork or referrals you need.
Know how to check a provider’s Medicare status and when you must get a doctor’s sign-off.
Finding Medicare-Approved Chiropractors
Check the Medicare Physician Compare tool or call Medicare at 1-800-MEDICARE to confirm a chiropractor accepts Original Medicare (Part B).
Ask the chiropractor if they bill Medicare directly and whether they accept Medicare assignment.
If they do not accept assignment, you may pay more out of pocket.
If you have a Medicare Advantage plan, call your plan or check its provider directory to see in-network chiropractors.
Ask about copays, prior authorization, and visit limits.
Keep a written estimate of costs before treatment.
The Modern Medicare Agency can help you find in-network chiropractors and explain costs for your plan.
Referral and Prescription Policies
Original Medicare (Part B) covers spinal manipulation only for treating a neuromusculoskeletal condition.
You do not usually need a referral to see a chiropractor, but Medicare requires that the treatment be medically necessary and related to a diagnosed condition.
Some Medicare Advantage plans may require a referral or prior authorization for chiropractic services.
Your primary care doctor may need to document the condition and recommend treatment to satisfy plan rules.
Keep copies of notes, orders, and any prior authorization letters in case Medicare or your plan requests proof.
Contact The Modern Medicare Agency if you need help understanding referral needs or getting documentation organized.
Billing and Claims Process for Chiropractic Services
You will need to document services clearly, use the right codes, and follow Medicare submission rules to get paid.
Accurate records and timely claims reduce denials and speed payment.
Submitting Claims to Medicare
When you bill Medicare for chiropractic spinal manipulation, use CPT code 98940–98942 for manipulation by hand.
Submit claims with the correct ICD-10 diagnosis that shows a subluxation or related spinal condition.
Include the date of service, place of service, and provider’s NPI on each claim.
Medicare limits coverage to manual manipulation of the spine.
If you bill for modalities, x-rays, or evaluations, check whether Medicare covers those services before submitting.
Use electronic claims (837P) when possible; they process faster than paper.
Follow timely filing rules—typically within one year of the date of service—unless a local contractor specifies otherwise.
Keep copies of documentation for at least five years in case of audit.
If a claim denies, review the denial reason, correct errors, and resubmit with supportive documentation.
Understanding Explanation of Benefits
Your patient will receive an Explanation of Benefits (EOB) that lists billed services, allowed amounts, Medicare payments, and patient responsibility.
Read the EOB line by line to confirm services, dates, and amounts match your records.
If the EOB shows a denial or reduced payment, note the denial code and reason.
Common reasons include lack of documented subluxation, incorrect coding, or services outside Medicare’s coverage.
Use the appeals process if you have supporting documentation; include progress notes, treatment plans, and imaging if relevant.
The Modern Medicare Agency can help you and your patients review EOBs and file appeals.
Medicare Advantage and Chiropractic Benefits
Medicare Advantage plans can change how much you pay, where you get care, and what chiropractic services you can use.
You may get broader benefits or face network rules and copays that differ from Original Medicare.
Differences from Original Medicare
Medicare Advantage (Part C) must cover at least the same chiropractic service Original Medicare covers: spinal manipulation for treating vertebral subluxation. But Advantage plans often add limits and requirements you should know.
Many plans use provider networks. If you see an out-of-network chiropractor, you may pay more or get no coverage.
Plans set copays, coinsurance, and plan-year limits that vary by plan and county. Prior authorization may be required for certain services or multiple visits.
Deductibles can apply before benefits start. Check each plan’s Evidence of Coverage for exact rules on visits, billing codes, and referral needs.
Additional Coverage Options
Some Medicare Advantage plans include extra chiropractic or musculoskeletal benefits beyond spinal manipulation. These extras can cover routine chiropractic visits, acupuncture, physical therapy, or wellness services.
Benefit amounts differ by plan. You might see a set number of covered visits per year, a dollar cap, or a reduced copay for in-network providers.
Plans may bundle these services in supplemental wellness packages or as part of a chronic condition program. Not every plan in every area offers these extras, so availability depends on your ZIP code.
Recent Changes and Updates to Chiropractic Medicare Policies
Congress has moved to expand Medicare’s coverage of chiropractic services. New bipartisan legislation seeks to let chiropractors bill Medicare for all services allowed under their state license, not just spinal manipulation.
This change would align Medicare with other federal programs and many private plans. You may gain access to therapies like joint mobilization and soft-tissue techniques through a chiropractor without switching providers.
If the bill passes, Medicare would still limit coverage to services that are medically necessary. Reimbursement rules would change only for which providers can be paid, not for adding entirely new services to the program.
Key points at a glance:
- Expansion focuses on allowing chiropractors to be paid for more covered services.
- Coverage remains tied to medical necessity and existing Medicare rules.
- Potentially faster access to non-drug pain treatments for beneficiaries.
Contact The Modern Medicare Agency to talk to a licensed agent and learn how these policy changes might affect your plan options.
Resources for Further Information
For clear, personalized help with chiropractic coverage under Medicare, contact The Modern Medicare Agency. You can speak one-on-one with a licensed agent who listens to your needs and explains options in plain language.
They help you find plans that fit your budget without hidden fees. Use official Medicare documents and the Medicare website to check rules about spinal manipulation and subluxation.
Bring questions to your agent so they can compare how Original Medicare and Medicare Advantage plans handle chiropractic services for you. Keep a list of questions before you call: What does my plan cover?
Are X-rays or other tests included? How much will I pay for each visit?
Your agent at The Modern Medicare Agency will walk through answers and show plan details side-by-side. If you prefer written guides, ask The Modern Medicare Agency for printed materials or email summaries.
Their agents provide straightforward comparisons, enrollment deadlines, and step-by-step help with claims or appeals if you need it. You can also request a free consultation to review your current plan and potential savings.
