How Many Chiropractic Visits Does Medicare Cover in a Year?

Original Medicare includes coverage for chiropractic visits but only for one type of treatment. Patients with subluxation of the spine are eligible for manual manipulation. You must have proof, from an X-ray or physical exam, that treatment is necessary.^[1]

Medicare Part B will cover 80% of the cost of treatment after you meet your annual deductible.^[2] You can also opt for a Medicare Advantage plan (Medicare Part C), which is a Medicare plan available from a private insurer. Medicare Advantage plans might include additional coverage for chiropractic care, but it varies from one insurer to the next.

Here’s how to determine how much chiropractic treatment your Medicare plan covers.

Eligibility criteria for chiropractic coverage

Original Medicare includes Medicare Part A and Part B. Part B covers medically necessary and preventative services. The plan covers some chiropractic care when it’s a medical necessity, but it’s limited to active treatment for chiropractic spinal manipulation.

Treatment can’t be indefinite. Your doctor’s assessment of a reasonable expectation for recovery or improvement from treatment will determine the number of covered visits.

Medicare Part B only covers active or corrective treatment for subluxation, which is the misalignment of vertebrae. Subluxation can be caused by aging, injuries, or specific health conditions. For example, patients with scoliosis often have subluxation.

Specifics of chiropractic coverage

Medicare Part B only covers manual manipulation of the spine, a hands-on treatment involving movement and pressure on the spine to increase functionality. Some chiropractors also offer additional services like acupuncture, physical therapy, and massage therapy, but Medicare Part B doesn’t cover those treatments.

Your Medicare health insurance will often cover the cost of diagnostic treatment to determine the condition, but a doctor must order the X-ray or perform the exam. Medicare doesn’t cover diagnostic tests or exams from a chiropractor.

The X-ray documentation must:

• Include a specific subluxation level

• Be from the last 12 months or within three months of starting treatment

Patients with chronic conditions can use an older X-ray, MRI, or CT scan.

The physical exam documentation must include the following:

• Documentation of pain, misalignment, range of motion abnormality, or tone change

• Information about the history of the condition, including family history or past health history

Patents must have documentation to access chiropractic services through Medicare Part B. It might sound like a complicated process, but you can start by scheduling a visit with your doctor and explaining your pain or areas of concern. In most cases, the documentation process occurs naturally as part of the diagnosis.

Medicare limitations on chiropractic visits

Medicare doesn’t mandate a maximum number of chiropractic visits, but you must require active treatment. Active treatment aims to correct acute or chronic subluxation. Doctors usually classify new injuries as acute subluxation. So if your pain is recent or due to an injury, it’s likely acute, and Medicare Part B would cover treatment.

When your pain is due to a long-term health condition that’s not likely to resolve, doctors consider it chronic. Chronic conditions can qualify for chiropractic coverage under Medicare Part B if doctors expect treatment to result in functional improvements. But once your condition is stable, you might lose coverage for chiropractic services if the provider doesn’t expect further improvement.

Cost considerations for chiropractic visits

Before coverage kicks in, you must meet your Part B annual deductible of $240. After your deductible, Medicare covers 80% of the cost of a visit, and you’re responsible for 20%.^[3]

The cost of a chiropractic visit depends on the treatment you need, the doctor, the hospital, and other factors. You can contact your healthcare provider to get an estimate. Once you know the total price, you can calculate your copay.

Whether or not you have supplemental Medigap insurance also affects how much you’ll pay for treatment.

Effect of supplementary insurance

Supplemental Medigap insurance can reduce your cost of chiropractic care. Some plans — like Plan G, Plan M, and Plan N — cover the Part B copayment, which means you won’t have to cover 20% of the cost of a chiropractic visit.^[4] Other plans, like Plan K and Plan L, cover a percentage of the Part B deductible, reducing costs.

You can also opt for a Medicare Advantage plan through a private insurer. Some plans include additional coverage for chiropractic visits, but it varies.

Medicare and chiropractic visits FAQs