Medicare Part B covers one Chiropractic service: manual manipulation of the spine to correct a subluxation, when it is medically necessary. That is the whole of it.
Everything else a chiropractor might do or order, including X-rays, massage, Acupuncture, examinations, therapies and supports, is not covered by Original Medicare when the chiropractor provides or orders it. Most of the confusion, and most of the surprise bills, come from that second sentence rather than the first.
Manual manipulation of the spine to correct a subluxation. A subluxation here means a spinal joint that is out of position and not moving as it should. The treatment has to be medically necessary and aimed at correcting that problem.
You pay the Part B deductible first, and then 20% of the Medicare-approved amount for each covered manipulation. Medicare pays the other 80%.
Under Original Medicare, when provided or ordered by a chiropractor:
This is not a Mountain View Pain Center policy. It is the shape of the benefit.
Medicare covers Chiropractic treatment while it is actively correcting a problem. Once you have reached maximum therapeutic benefit, the point where further adjustments keep you comfortable rather than improve anything, coverage for that episode ends. Continuing past that point is maintenance care, and you pay for it yourself.
There is no annual cap on the number of visits. The limit is not a count; it is whether the care is still actively corrective and medically necessary. That is why two people can have very different numbers of covered visits for what sounds like the same complaint.
On claims, active treatment is flagged with a modifier. If that documentation is not right, Medicare denies the claim, which is a billing matter rather than anything about your care, but it is the usual reason a visit you expected to be covered comes back unpaid.
Medicare Advantage plans must cover at least what Original Medicare covers, so spinal manipulation for a subluxation is covered under every one of them.
Many go further. Some include maintenance visits, some include X-rays ordered by a chiropractor, some include additional therapies, and some set a fixed copay per visit instead of 20% coinsurance. Some also require a referral, because many are built on an HMO structure.
The variation between plans is wide enough that a general answer is not much use. Read your plan's Evidence of Coverage, or call the number on your card and ask what Chiropractic benefit it includes and whether a referral is required. Mountain View Pain Center is in network with most Medicare Advantage plans, and we verify yours specifically before your first visit.
The practical consequence is worth saying plainly: at a Chiropractic visit under Original Medicare, the adjustment is covered and the other things that might happen in the same appointment generally are not.
So we check your benefits before you come in, tell you which parts of a proposed plan Medicare will cover and which it will not, and tell you the cost of the uncovered parts before they happen rather than afterwards. If your plan will not cover something we think would help, that is a conversation to have in advance, and sometimes the answer is a physician-ordered version of the same thing, which is covered.
If the Chiropractic benefit is not the right fit. Chiropractic is one of four services under one roof, alongside Pain Management, Physical Therapy and Acupuncture, and they are billed under different rules. Physical Therapy and physician services have their own Part B coverage, which is broader than the Chiropractic benefit, and imaging ordered by a physician is covered where the same imaging ordered by a chiropractor is not. For some Medicare patients the sensible route is an evaluation with a Pain Management physician who can order what is needed and direct the plan, with Chiropractic as one component rather than the entry point.
No referral is needed to be seen. Appointments are usually available within the same week.
Medicare in Arizona: read what to check about a Medicare Advantage plan before you switch, or, if you spend the season here, pain management for winter visitors.
Every clinic below has Chiropractic, Physical Therapy, Acupuncture and Pain Management on one chart, so care can move between them without a new referral.
Downtown out through the north, west, south and east suburbs.
Academy, Interquest and Tenderfoot cover the north, central and south of the city.
Harmony in Fort Collins and our Greeley clinic serve Larimer and Weld counties.
Across the Valley, from the West Valley through Phoenix to the East Valley.
Yes. Medicare Part B covers manual manipulation of the spine to correct a subluxation when it is medically necessary. After your Part B deductible you pay 20% of the Medicare-approved amount.
No. Medicare does not cover X-rays ordered by a chiropractor. Imaging ordered by a physician is covered under Part B as an ordinary diagnostic service.
There is no annual limit on visits. Coverage continues while the treatment is medically necessary and actively correcting a problem, and ends once you have reached maximum therapeutic benefit for that episode.
No. Once care is maintaining your comfort rather than correcting a problem, it is maintenance and you pay for it yourself.
Often, yes. Every Medicare Advantage plan must cover at least spinal manipulation for a subluxation, and many add maintenance visits, X-rays or extra therapies. Benefits vary by plan, and many plans require a referral, so check yours directly.
We check your benefits before you come in and tell you which parts of a plan Medicare will cover and which it will not. Mountain View Pain Center is in network with most Medicare Advantage plans, and appointments are usually available within the same week.
