Medicare Coverage of Chiropractic Services
Medicare Part B pays for a chiropractor's manual manipulation of the spine to correct a subluxation. Manual devices (for example: those that are hand-held and controlled by hand of the doctor) may be used by chiropractors in performing manipulation of the spine. However, no additional payment is allowed for the use of such a device.
Medicare does not cover the following services of a chiropractor:
- Initial physical examinations
- Evaluation services
- Physical therapy
- Vitamin, mineral and/or food supplements, or other supplies
- Orthopedic devices
Chiropractic Treatment is Covered by Medicare if:
- You have a health problem in the form of a neuro-musculoskeletal condition that needs treatment (such as pain, inflammation, swelling, lower extremity numbness, etc.)
- You have a subluxation of the spine and manual manipulation has been recommended for improvement of your condition
What You Will Need to Pay for Chiropractic Treatment.
You will have to pay the Part B deductible, and then 20% of the Medicare-approved amount unless you have a medicare supplement that will cover those gaps in coverage. Many traditional Medicare Supplemental insurance plans will pay both the deductible and the co-insurance of 20 percent. Medicare reimbursement is limited to one visit per day for chiropractic treatment, unless there is a medical need for more than one visit each day. The hands-on nature of chiropractic treatment requires patients to receive such treatments 3-4 times per week. A chiropractor may provide acute or chronic care, thus making a certain number of visits sometimes necessary. Each visit must be medically necessary. Once further improvement cannot reasonably be expected from ongoing care, the treatment is considered supportive/preventive, and Medicare will stop paying for treatment.
What You Can do Before Choosing a Provider of Chiropractic Services.
- Ask the doctor if they are a participating provider with Medicare
- Find out If they accept assignment of benefits from Medicare
- Ask them to inform you what they will charge and what your share of the payment will be.
If the chiropractor does not accept assignment: You may have to pay more than the Medicare-approved amount, usually 15% more. You may have to pay the entire cost of your services at the time they are performed. You may have to bill Medicare yourself and wait several weeks before you will be reimbursed. If the chiropractor does not participate in Medicare, Medicae will not pay the claim. You must have paid your annual deductible for services and supplies before Medicare will begin to pay its share unless you have a good Medicare supplement plan that covers those gaps in coverage. You may pay little or nothing if you are covered by a Medigap insurance plan. Medicare Advantage plans often do not cover chiropractic or may require some type of co-pay.