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.
Important Information
You must have recent proof of subluxation to receive care since Medicare Part B doesn’t cover maintenance therapy or preventative care. To qualify for treatment from a chiropractor, Original Medicare patients must have documentation from a doctor to prove that there’s a misalignment. This documentation can come in the form of X-ray results or a physical exam.
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:
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.