Medicare and Chiropractic Care
- Medicare may cover some chiropractic care, but only in certain situations. Learn more to make the most of your Medicare insurance when you visit the chiropractor.
Many older adults suffer from back problems and require the care of a chiropractor. But are chiropractic services covered by Medicare?
Medicare Part B covers chiropractic care if it includes manual manipulation of the spine to correct a subluxation. This service, more commonly known as an “adjustment,” must be performed by a chiropractor or other qualified provider and must be considered medically necessary by a doctor in order for Medicare to cover the chiropractic services.
You do not need to have an X-ray to prove that you have a subluxation or to qualify for Medicare-covered treatment. However, in order for any chiropractic care to be covered by Medicare, it must be designed to correct an existing condition and not for maintenance or preventive purposes.
Beneficiaries will typically pay a 20% copay for the Medicare-approved amount of the service after meeting their annual Part B deductible (which is $198 for the year in 2020).
Does Medicare Cover Other Spine Care Services?
Outside of treatment for a subluxation, Medicare coverage for back and spine treatment remains limited. Original Medicare (Part A and Part B) does not cover other services or tests ordered by a chiropractor, such as X-rays or massage therapy.
Does Medicare Cover Acupuncture?
In January 2020, the Centers for Medicare and Medicaid Services (CMS) issued a ruling that Medicare Part B will now cover acupuncture. Prior to 2020, acupuncture was not covered at all by Medicare.
Medicare will now cover up to 12 acupuncture visits within a 90-day period for patients with chronic lower back pain. Chronic lower back pain is defined as pain that persists for 12 months or longer and is not known to be associated with surgery, pregnancy, cancer or infectious disease.
If a patient shows improvement, Medicare will then provide coverage for an additional eight sessions. No more than 20 sessions will be covered in any calendar year.
Does Medicare Cover Physical Therapy?
Medicare Part B typically covers outpatient physical therapy that is determined by a doctor to be medically necessary. This coverage can include physical therapy designed to help a patient recover from a back or spine injury.
Does Medicare Pay for Back Braces?
Medicare Part B covers back braces when deemed medically necessary by your doctor. A back brace falls under the Medicare coverage category of durable medical equipment (DME).
How Does Medicare Cover Back Surgery?
Medicare Part A can cover medically necessary back surgeries to alleviate pain and restore motion.
Do Private Medicare Plans Cover Spinal Care?
Medicare Advantage plans (also called Medicare Part C) are sold by private insurers and are allowed to offer extra benefits not covered by Medicare Part A or Part B. These extra benefits typically include prescription drug coverage and may include additional coverage for chiropractic care, depending on the plan you have.
Medicare Part D plans (along with many Medicare Advantage plans) provide coverage for prescription medications and may cover some drugs used to alleviate back pain. Medicare Part D does not, however, provide coverage for medical services.
What Is Spinal Subluxation?
The term “subluxation” describes an altered position of the vertebra and the resulting loss in function. Subluxation is a process in which tissues in the spine experience changes such as a buildup of blood or toxins, damaged or pressurized blood vessels or shrinking muscles over time.
Subluxation can cause pain in the back and neck, headaches and limited range of motion. The subluxation can be treated by a chiropractor using a high velocity arm thrust applied to the vertebra. This motion releases gas from the spinal joints and restores the spine to its proper position. The subluxation process typically begins again and requires regular visits to the chiropractor for adjustments.
When seeking chiropractic care, it’s important to find a chiropractor who accepts Medicare assignment so that you will not incur any Medicare Part B excess charges. Or if you have a Medicare Advantage plan, be sure the chiropractor you visit is part of your plan’s network of participating providers.