Medicare covers chiropractic care when prescribed to treat lower back pain.
Medicare provides health insurance for American citizens aged 65 and older, as well as those who have certain disabilities or illnesses. Services deemed medically necessary by a healthcare provider are usually covered by either Medicare Part A or Medicare Part B. In this post, we answer the question: Does Medicare cover chiropractic care?
When Does Medicare Cover Chiropractic Care?
Yes, Medicare Part B covers spinal manipulation to correct a subluxation if such treatment is deemed medically necessary by your doctor. The service must be provided by a chiropractor or other provider who is qualified to perform the procedure.
A subluxation is when one or more of the bones in your spine is out of position. Spinal manipulation is one of the most common chiropractic procedures.
Please note that Medicare will not cover any additional services from the chiropractor. This includes:
- Massage therapy
Your cost for this service is 20 percent of the Medicare-approved amount and the Part B deductible applies.
How Many Chiropractic Visits Does Medicare Cover?
As of 2020, there is no set number of chiropractic visits that Medicare will cover. It depends on what your doctor deems medically necessary.
Medicare defines medically necessary as any healthcare services or supplies that meet the standards of medicine and are used to diagnose or treat illness, injury, or disease.
Does Medicare Advantage Cover Chiropractic Care?
Medicare Advantage plans must provide the same level of coverage that you get with Original Medicare. This includes Part A, hospital insurance, and Part B, medical insurance. And, since Medicare Part B covers spinal manipulation to treat a subluxation, Medicare Advantage plans must offer the same coverage.
Most Advantage plans, however, provide coverage that goes beyond what you get with Original Medicare. Check your plan's benefits to see what types of chiropractic services it covers.
Does Medigap Cover Chiropractic Care?
Medicare Supplement Insurance, more commonly known as Medigap, helps pay some of your out-of-pocket costs under Original Medicare.
If Medicare Part B covers the service, then Medigap Plans A, B, C, D, F, G, M, and N will cover 100 percent of the 20 percent coinsurance amount. Medigap Plan K covers 50 percent of your Part B coinsurance and Plan L covers 75 percent.
Use our Find a Plan tool to compare your Medigap and Medicare Advantage plan options. Just enter your location and coverage start date to begin reviewing Medicare plans in your area.
How to Bill Medicare for Chiropractic Services
It is exceedingly rare for patients who have Original Medicare to have to bill or submit a request for payment. Instead, your provider submits the claim.
Your provider has 12 months to file a payment request. Medicare pays its share and then the provider then bills you for the 20 percent coinsurance. If you have a Medicare Supplement plan, Medicare sends them the bill for the remaining 20 percent. (This assumes you have already met your Medicare Part B annual deductible.)
You have two options to determine whether your chiropractor billed Medicare for the services provided:
- The Medicare Summary Notice you receive each quarter
- Your MyMedicare.gov account
If no claim has been made and that 12-month deadline is approaching, you should call 1-800-MEDICARE (633-4227). Explain the situation and tell the Medicare representative that you need to file a claim.
Click here to find the link to Form CMS-1490S, detailed instructions on how to complete it, and where to send it.