Are you bothered by back pain or a stiff neck? Perhaps you’re one of the 16 percent of adults in the United States who’ve seen a chiropractor in the last 12 months.1
More than half of American adults visit chiropractors when they have spinal pain. They trust these health professionals for their safe and effective treatment methods.
If you rely on chiropractors to manage your musculoskeletal pain, you may wonder whether Medicare covers the chiropractic care services you need. Medicare Part B and Medicare Advantage plans (Medicare Part C) do cover chiropractic care. Learn more about what services are covered and how much you might expect to pay.
Chiropractic services can help people with spine, joint and muscle problems. Chiropractors use several methods to gain a comprehensive understanding of their patients’ problems and how to treat them. They often spend time interviewing their patients to find out their health concerns and history, perform physical exams and may order X-rays.
Chiropractors use this information to develop treatment plans that reduce pain and improve patient mobility. As part of these plans, they perform various therapies to help their patients, including:
Chiropractors track each patient’s recovery and adjust treatment plans as needed for the best health outcomes.
Chiropractors offer a non-surgical, drug-free treatment option for a variety of health conditions. Their treatments can complement other medical options or form a standalone treatment plan.
Chiropractors regularly see patients with the following conditions:
If one or more of your spinal bones have moved out of position, you have a subluxation. Since July 1, 1973, Medicare Part B covers chiropractic visits to correct subluxation.2
Your chiropractor must satisfy Medicare’s licensure requirements and other conditions outlined in the Medicare Benefit Policy Manual for Medicare to cover chiropractic care.
Under Original Medicare (Medicare Part A and Part B) or Medicare Advantage insurance plans (Medicare Part C), you’ll typically pay 20% of the Medicare-approved amount for treatment and your Part B deductible.
Medicare will pay the remaining 80% of your chiropractic treatments. Some Medicare Advantage plans may have different coinsurance and deductible requirements, so be sure to check with your plan carrier directly to confirm how much your chiropractic care will cost.
The exact amount you’ll pay depends on a variety of factors, including:
Your chiropractor or a customer service assistant at their practice should be able to estimate out-of-pocket costs for you before you receive any services.
Medicare coverage can extend to as many chiropractic visits as you need to correct your subluxation.
The Medicare carrier or Medicare Administrative Contractor (MAC) might review your medical records during your treatment to ensure you still need the therapy. However, there are no caps or limits on the number of visits Medicare covers as long as they are medically necessary.
Chiropractors use a range of Current Procedural Treatment (CPT) codes when billing Medicare for patient services. Medicare covers the following chiropractic codes:
Chiropractors must also add the AT modifier code to CPT Code 98940, 98941, or 98942. This modifier shows the patient is receiving acute treatment. Without this modifier, Medicare assumes the patient is having maintenance treatment and denies the claim.
Original Medicare only covers the CMT services needed to correct a subluxation. It does not cover any of the following:
Your chiropractor may recommend services Medicare doesn’t cover. It’s a good idea to ask your chiropractor questions about why these services matter to decide whether you want to pay for them.
Note that you don’t have to consent to any services Medicare doesn’t cover. You can make it clear that you only want Medicare-subsidized treatment. If you think your chiropractor is billing you for services that Medicare won’t cover and you haven’t consented, you can report this to Medicare.
It’s also important to remember that Medicare Advantage plans are offered by private insurance companies and may often offer benefits that Original Medicare doesn’t cover. Some Medicare Advantage plans may offer more chiropractic services than what Original Medicare covers, though benefits can vary from one plan to another.
Many people suffering from chronic pain investigate several options for reducing their discomfort. Original Medicare can help with the cost of some of these treatments, but not all:
Again, keep in mind that some Medicare Advantage plans may offer more coverage for services such as acupuncture, massage, physical therapy than Original Medicare covers.
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1 Gallup and Palmer College of Chiropractic. (2018). Gallup-Palmer College of Chiropractic Annual Report: Managing Neck and Back Pain in America. https://www.palmer.edu/getmedia/50bd459e-aaf2-4969-844d-555e421835a3/palmer-gallup-annual-report-2018.pdf.
2 Social Security Administration. 1972 Social Security Amendments. https://www.ssa.gov/history/1972amend.html.