Does Medicare Cover Chiropractic?

🔑 10 Key Takeaways (Quick Answers Before the Deep Dive)

1. Medicare only covers one thing at the chiropractor. Manual manipulation of the spine to correct a vertebral subluxation — that’s it.

2. No annual visit cap exists — but there’s a hidden catch. Medicare Part B chiropractic coverage does not have visit limits for the year, and as long as care is medically necessary, it will continue to be covered. However, once you stop improving, they stop paying.

3. You’ll pay 20% after the deductible. For 2026, the Medicare Part B deductible is $283, and after that, Medicare pays 80% of the approved amount.

4. X-rays, massage, exams, and acupuncture ordered by your chiropractor? Not covered. Medicare doesn’t cover other services or tests a chiropractor orders, including X-rays, massage therapy, and acupuncture.

5. Neck pain alone won’t qualify. Treatment for general back or neck pain that comes from overuse or strain is not included in benefits. The chiropractor must document a subluxation.

6. Sciatica by itself isn’t covered for chiropractic. Medicare doesn’t cover chiropractic care for sciatica specifically — it will only cover spinal manipulation for vertebral subluxation.

7. Medicare Advantage may offer extras. Some Part C plans cover routine chiropractic visits, diagnostic X-rays, and office exams beyond what Original Medicare provides.

8. A major reform bill is pending in Congress right now. The Chiropractic Medicare Coverage Modernization Act of 2025 (S.106/H.R.539) would expand recognition of chiropractors as “physicians” under Medicare for all services within their state license scope.

9. Blue Cross Blue Shield covers chiropractic in most plans — but visit limits, referral requirements, and copays vary wildly by state and plan tier.

10. California’s Medi-Cal has some of the most restrictive chiropractic rules in the country — limited to a maximum of two services per calendar month and generally only through federally qualified health centers.

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Yes, Original Medicare Covers Chiropractic — But Only One Extremely Specific Treatment

Here’s the uncomfortable truth that chiropractor offices sometimes gloss over: spinal manipulation is the only type of treatment Medicare Part B will cover, involving a controlled thrust to the spine to correct bones that are out of position, called spinal subluxation.

That word — subluxation — is everything. It’s the diagnostic key that unlocks Medicare coverage. Without it documented in your medical record, your claim gets denied regardless of how much pain you’re experiencing.

🏥 Service	✅ Covered?	💡 What You Need to Know
Manual spinal manipulation for subluxation	✅ Yes	Must be “medically necessary” and show improvement
Chiropractor-ordered X-rays	❌ No	Physician-ordered X-rays may be covered separately
Initial exam/evaluation	❌ No	You pay 100% for the exam itself
Massage therapy	❌ No	Never covered through chiropractic benefit
Acupuncture at chiropractor	❌ No	Covered separately for chronic low back pain only if ordered by MD
Maintenance/wellness adjustments	❌ No	Coverage ends when you stop improving
Extremity adjustments (knees, shoulders)	❌ No	Spinal manipulation only

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There’s No Annual Visit Cap — But Medicare Uses a Sneaky “Improvement Standard” Instead

This is where most articles mislead seniors. They’ll say “unlimited visits!” and leave it there. The reality is far more nuanced.

Medicare does not use a traditional visit cap for chiropractic care, but it does impose functional improvement requirements. This means coverage depends on your progress, not just the number of visits. If care is considered ongoing or maintenance-based, Medicare may deny payment.

In plain English: Medicare pays until your chiropractor can no longer document that you’re getting measurably better. The moment treatment becomes “maintenance” — keeping you stable rather than actively correcting a problem — the coverage tap shuts off. And this determination can happen at visit 8 or visit 80.

What “active treatment” vs. “maintenance care” looks like on your bill:

📋 Billing Detail	🔑 Active Treatment (Covered)	⛔ Maintenance Care (Denied)
AT modifier on claim	✅ Present	❌ Missing
Progress notes	Show measurable improvement	Show stable condition
Treatment goal	Correcting subluxation	Preventing recurrence
Medicare payment	80% after deductible	$0 — you pay everything

For Medicare purposes, a chiropractor must place an AT modifier on a claim when providing active/corrective treatment for acute or chronic subluxation. If your chiropractor forgets this modifier or can’t justify continued improvement, your claim gets rejected.

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How Much Does Medicare Actually Pay for a Chiropractic Adjustment? (The Real Dollar Breakdown)

The math surprises most people — and not in a good way.

In areas like south Florida, the Medicare reimbursement rate for a spinal adjustment to 1-2 areas is $26.75, and for 3-4 areas is $38.71. These rates are national averages that shift slightly by region but give you a realistic picture.

💰 Cost Scenario	Before Deductible Met	After $283 Deductible Met
1-2 region adjustment (~$26.75)	You pay $26.75	You pay ~$5.35 (20%)
3-4 region adjustment (~$38.71)	You pay $38.71	You pay ~$7.74 (20%)
With Medigap supplement	You pay $26.75-$38.71	Medigap covers remaining 20% = $0
Non-participating chiropractor	Potentially more than approved amount	May balance-bill above Medicare rate

Critical money-saving detail: If your chiropractor doesn’t accept Medicare assignment, you might pay more than the standard coinsurance amount. Always confirm your chiropractor is a “participating provider” before your first visit.

And here’s the kicker that stings: Medicare’s 2025 Physician Fee Schedule introduced a 2.8% payment cut for chiropractic codes 98940 through 98942. That means chiropractors are getting paid less, which makes some less willing to accept Medicare patients.

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Does Medicare Cover Chiropractic for Neck Pain? (It’s Complicated)

This is where the subluxation requirement becomes painfully relevant.

Medicare coverage for chiropractic care is very limited, and treatment for general back or neck pain that comes from overuse or strain is not included in benefits.

So if you walk in saying “my neck hurts from sleeping wrong,” that’s not covered. But if your chiropractor examines you, identifies a cervical subluxation at C4-C5 causing your neck pain, and documents it as the primary diagnosis — now you’re in Medicare territory.

The location of subluxation is required in medical records, including the neck region: Occiput or Cervical at levels C1 through C7.

The insider tip most articles miss: Ask your chiropractor to perform a thorough evaluation specifically looking for subluxation rather than just treating “neck pain.” The diagnosis determines whether Medicare pays or you pay.

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Does Medicare Cover Chiropractic for Sciatica? (The Honest Answer is Mostly No)

Sciatica is nerve pain radiating down the leg, usually caused by a compressed nerve root in the lower spine. Millions of seniors suffer from it. And here’s what nobody wants to tell you:

Medicare doesn’t cover chiropractic care for sciatica specifically. It will only cover spinal manipulation for vertebral subluxation. However, Medicare does cover treatment for sciatica — just through other providers and services.

The workaround most chiropractors use: If your sciatica is caused by a lumbar subluxation (say at L4-L5), the chiropractor codes the subluxation as the primary diagnosis. The sciatica becomes the secondary condition. Medicare pays for correcting the subluxation — and if that happens to relieve your sciatica, everyone wins.

In certain circumstances, individuals who suffer from sciatica or lower back-related pain can receive some Medicare coverage if they require lumbar epidural steroid injections to alleviate pain. These injections are performed by physicians, not chiropractors, and covered under a different Medicare benefit.

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Does Medicare Cover Chiropractic for Seniors? (Why the 1972 Law Is Still Holding Everyone Hostage)

Every Medicare beneficiary — all 67+ million of them — gets the same restrictive chiropractic benefit regardless of age, health status, or how much pain they’re in. The coverage established in 1972 has seen almost no meaningful expansion.

The current statute restricts beneficiaries to one service in a chiropractic clinic, and Medicare chiropractic coverage has not kept up with private sector coverage or other federal health delivery systems.

Consider this comparison:

🏛️ Federal Program	🩺 Chiropractic Coverage Level
Medicare (civilians 65+)	Spinal manipulation for subluxation only
Veterans Affairs (VA)	Broader chiropractic services within scope of practice
Department of Defense (active military)	Comprehensive chiropractic care
Federal Employees (FEHB)	Coverage mirrors private insurance
Private insurance (typical plan)	Exams, X-rays, adjustments, sometimes extremities

The disparity is striking. A 70-year-old retired federal employee gets better chiropractic coverage through their former employer plan than through Medicare. The bipartisan Chiropractic Medicare Coverage Modernization Act (S.106/H.R.539) aims to fix this, but this bill hasn’t become law yet, and current Medicare coverage remains limited to spinal manipulation for subluxation.

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The Medicare Chiropractic Billing Trap Your Provider Might Not Warn You About

This section is pure consumer protection — the kind of information that prevents surprise bills.

All services other than manual manipulation of the spine for treatment of subluxation are excluded when ordered or performed by a Doctor of Chiropractic. That means if your chiropractor does an exam, takes X-rays, applies electrical stimulation, performs soft tissue work, and then adjusts your spine — Medicare only pays for the adjustment. Everything else is your bill.

Red flags that mean you’re about to pay out-of-pocket:

Your chiropractor should give you an Advance Beneficiary Notice (ABN) before performing any service that Medicare won’t cover. If the provider uses the AT modifier and believes a service is likely to be denied by Medicare as not medically necessary, the beneficiary must sign an ABN.

If you’re never asked to sign an ABN but keep getting bills for non-covered services, something is wrong with the communication at that office.

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Medicare Chiropractic Coverage: State-by-State Breakdown (The Table Nobody Else Created)

Federal Medicare (Part B) coverage is identical nationwide — subluxation correction only. But state-level Medicaid programs and Medicare Advantage plan availability create dramatically different landscapes depending on where you live.

🗺️ Medicaid/Medi-Cal Chiropractic Coverage by State

State	Medicaid Covers Chiro?	Key Restrictions	🔍 Notes
🌴 California	Limited	Max 2 visits/month, FQHC/RHC only	Among the most restrictive in the nation
🗽 New York	Not reported	State mandates private plans include chiro	Medicaid coverage unclear
🤠 Texas	No standard benefit	Children via EPSDT only	Adults pay out-of-pocket
☀️ Florida	Yes	Visit limits apply	Coverage for eligible adults
🌲 Oregon	Yes (OHP)	Requires PCP referral	In-network providers only
🏔️ Michigan	Yes	Full coverage available	One of the most generous states
❄️ Minnesota	Yes	Full coverage available	Comprehensive benefits
🌽 Iowa	Yes	Per benefits manual	Includes adults
🍑 Georgia	No	Children via EPSDT only	No adult Medicaid chiro benefit
🌊 Washington	Limited	Children, pregnant, Medicare dual-eligible	Most adults excluded
🏖️ Illinois	Yes (2021)	25-visit limit for some plans	Approved relatively recently
🎵 Louisiana	Yes (2022)	Effective Aug 2022	Recent addition
🦀 Maryland	No	—	No Medicaid chiro benefit
🌸 Connecticut	Yes (2020)	Reinstated after gap	Was previously eliminated

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Does Medicare Cover Chiropractic in California? (A Special Deep Dive)

California deserves its own section because the coverage picture is uniquely frustrating here.

Federal Medicare in California works the same as every other state — subluxation-related spinal manipulation at 80% after the $283 deductible. No referral needed. Any Medicare-participating chiropractor can treat you.

Medi-Cal (California’s Medicaid) is where things get restrictive. Chiropractic services are limited to a maximum of two services per month, in combination with audiology, acupuncture, occupational therapy, and speech therapy services. That means if you use one of those two monthly slots for acupuncture, you only get one chiropractic visit.

Even more limiting: chiropractic services are covered for Medi-Cal members only when provided by a contracting FQHC or RHC provider. You can’t just go to any chiropractor in California on Medi-Cal — you must visit a federally qualified health center or rural health clinic that has a chiropractor on staff, and those are not exactly on every corner.

Children under 21 in California get significantly better access through the EPSDT program, with no fixed visit caps and fewer facility restrictions.

🐻 California Coverage	Medicare	Medi-Cal (Adults)	Medi-Cal (Under 21)
Spinal manipulation	✅ Yes	✅ Yes (FQHC/RHC only)	✅ Yes (broader access)
Monthly visit limit	None (medical necessity)	2/month (shared with other services)	No fixed cap
X-rays	❌ Not via chiropractor	❌ Not via chiropractor	Varies
Referral needed	No	Through managed care plan	Through plan
Maintenance care	❌ No	❌ No	❌ No

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Is Chiropractic Covered by Blue Cross Blue Shield? (The Short Answer Is Yes — The Long Answer Is “It Depends on Everything”)

Most Blue Cross Blue Shield plans include chiropractic benefits, often covering spinal adjustments, therapy treatments, and musculoskeletal care. But BCBS operates through independent regional companies across 50 states, so “BCBS coverage” is really dozens of different policies.

What most BCBS plans typically cover:

Spinal adjustments, an initial evaluation, and basic X-rays. Some plans include therapeutic exercises, electrical stimulation, and manual therapy.

What varies dramatically between BCBS plans:

Visit limits (anywhere from 12 to 60+ per year), referral requirements, copay amounts, in-network vs. out-of-network rules, and whether maintenance care qualifies.

BCBS Medicare Plus Blue plans (effective January 2026) provide coverage for one set of diagnostic X-rays and one routine office visit at no cost annually — benefits that Original Medicare doesn’t offer at all for chiropractic.

💙 BCBS Plan Type	Typical Chiro Benefits	⚠️ Watch Out For
PPO (employer)	20-40 visits/year, in/out-of-network	Higher out-of-network copays
HMO (employer)	12-30 visits/year, in-network only	Must get PCP referral first
Medicare Advantage (BCBS)	Original Medicare + enhanced benefits	Varies by county and plan tier
Individual/ACA Marketplace	Usually covered as essential benefit	Annual limits common
Medigap (BCBS supplement)	Covers 20% coinsurance on Part B services	Only if Original Medicare covers the service first

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The 2025 Reform Bill That Could Change Everything (But Hasn’t Yet)

The Chiropractic Medicare Coverage Modernization Act would allow Medicare beneficiaries access to the chiropractic profession’s broad-based, non-drug approach to pain management, including manual manipulation of the spine and extremities, evaluation and management services, and diagnostic imaging.

If passed, this bill would mean chiropractors could bill Medicare for exams, X-rays, extremity adjustments, and evaluation services — basically treating chiropractors the same way Medicare treats other physicians.

The bill does not add new services to Medicare; it simply allows for patient choice when selecting a provider. In other words, if a medical doctor can bill Medicare for evaluating your back pain, your chiropractor could too — as long as their state license permits it.

The bill has bipartisan support and was reintroduced in 2025, but it has not been signed into law as of early 2026. Seniors should plan based on current rules, not potential changes.

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🧠 Frequently Asked Questions

How often will Medicare pay for chiropractic? There is no hard frequency limit. If you had 20 visits and they were all medically necessary, they are covered. The same would be true with 30 visits, or any number. The trigger that ends coverage is when you stop showing functional improvement — not a visit counter.

Do I need a referral to see a chiropractor under Medicare? No, you don’t need a referral to see a chiropractor under Original Medicare. However, if you’re enrolled in a Medicare Advantage plan, you will most likely need prior authorization.

Can my chiropractor bill Medicare for the exam? No. All services other than manual manipulation of the spine for treatment of subluxation are excluded when ordered or performed by a Doctor of Chiropractic. You’ll pay for the exam out of pocket.

What’s the difference between the AT modifier and the GY modifier on my bill? The AT modifier signals active, corrective treatment that Medicare should pay for. The GY modifier signals a service that is statutorily excluded from Medicare — meaning you’re responsible for the entire cost. If you see GY codes piling up, those are out-of-pocket charges.

Will Medicare Advantage cover more than Original Medicare for chiropractic? Often, yes. Chiropractic spinal manipulation remains a covered benefit under all Medicare Advantage plans for 2026, and many Part C plans add benefits like routine visits, X-rays, and reduced copays. Always check your specific plan’s Evidence of Coverage document.

What if I have both Medicare and Medicaid (dual-eligible)? This can actually work in your favor. Medicare lets you see any participating chiropractor (not just FQHCs), and Medicaid can pick up the 20% coinsurance that Medicare leaves behind.

Does Medicare cover chiropractic care after back surgery? Only if there’s a documented subluxation requiring manual correction. Post-surgical rehabilitation is more commonly covered through physical therapy benefits, not chiropractic.

Why did my Medicare chiropractic claim get denied? The most common reasons: missing AT modifier on the claim, subluxation not listed as the primary diagnosis code, insufficient documentation of functional improvement, or the treatment was classified as maintenance care rather than active correction.

How do I find a chiropractor who accepts Medicare? Search the provider directory at Medicare.gov under “Find & compare providers.” Filter by provider type and enter “chiropractic” as the keyword. Always call the office directly to confirm they’re still accepting new Medicare patients — the directory can lag behind reality.

Is there any way to get fully covered chiropractic care on Medicare? The closest option is combining a Medicare Advantage plan that offers enhanced chiropractic benefits with selecting a chiropractor who accepts assignment. Some MA plans offer $0 copay chiropractic visits for a set number of visits per year. Beyond that limit, you’re back to Original Medicare rules — or out-of-pocket.

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This article reflects Medicare policy as of early 2026. Coverage rules can change with each annual Medicare update cycle. Always verify your specific plan’s Evidence of Coverage document before scheduling treatment, and ask your chiropractor’s billing office to confirm what will and won’t be submitted to Medicare before your first visit. Your spine — and your bank account — will thank you for asking the uncomfortable questions upfront.