Does Medicare Cover Chiropractic Services?
If you’re wondering if Medicare covers chiropractic care, the answer is yes, but with specific limitations. Medicare might cover chiropractic services only for spinal subluxation through manual manipulation.
However, this might not extend to maintenance therapy, other chiropractic services, or associated tests like X-rays. This article will guide you through the nuances of what Medicare could cover chiropractic-wise, what it doesn’t, and the potential costs involved.
Key Takeaways
- Medicare may cover chiropractic care specifically for spinal subluxation through manual manipulation but does not cover ongoing, maintenance care, preventive visits, or alternative treatments such as massage therapy and acupuncture.
- Diagnostic services like X-rays or tests ordered by a chiropractor may not be covered by Medicare, which could potentially lead to out-of-pocket expenses for patients, and may call for a clear understanding of the potential coverage limitations.
- Some of the Medicare Advantage plans may offer broader coverage for chiropractic services than traditional Medicare, but benefits may vary among plans and might require patients to compare plans carefully to understand chiropractic benefits and possible out-of-pocket costs.
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Understanding Medicare Chiropractic Coverage
Chiropractic care is a healthcare discipline that focuses on diagnosing and treating mechanical disorders of the musculoskeletal system, particularly the spine. It will likely encompass a range of techniques and therapies, including:
- Soft tissue therapy
- Exercise recommendations
- Lifestyle counseling
- Joint manipulation
Despite the breadth of chiropractic treatments, Medicare’s coverage may be specific and limited.
Chiropractic services, specifically for spinal subluxation – a condition where the spine’s vertebrae are misaligned – may be covered by Medicare through manual manipulation. Yet, once the spine is realigned, ongoing or maintenance chiropractic care might not be included in the coverage.
The coverage will likely hinge on medical necessity, implying that to qualify, the treatment has to be crucial for diagnosing or addressing a medical condition and its symptoms, conforming to established medical standards.
Spinal Subluxation and Medicare
Spinal subluxation is a condition where the alignment, movement, and physiological function of the spine deviate from the normal structural condition. This misalignment might cause pain, discomfort, and other health issues. Medicare will likely recognize spinal subluxation as a condition that could be addressed through chiropractic care.
The coverage provided by Medicare may be specifically for spinal subluxation that could be treated through manual manipulation, a technique where the practitioner uses their hands or a device to apply a controlled thrust to the misaligned joint of the spine.
However, it’s important to note that the coverage provided by Medicare may only be limited to treatment for spinal subluxation and does not extend to preventive chiropractic care.
Manual Manipulation of the Spine
Manual manipulation of the spine is a chiropractic technique that involves using hands or a device to apply a controlled thrust to a joint of the spine. The force applied may vary, but it’s intended to move the joint beyond its natural range of motion. This will likely represent the main treatment for spinal subluxation that Medicare covers.
This technique aims to realign the vertebrae to their original position and alleviate nerve compression. This could help address the pain and stiffness associated with spinal subluxation. However, keep in mind that once the spine is realigned, Medicare might not offer coverage for ongoing or maintenance chiropractic care.
Chiropractic Services Not Covered by Medicare
While Medicare may cover chiropractic care for spinal subluxation, it does not provide blanket coverage for all chiropractic services. There may be specific services, particularly preventive visits and alternative treatments, that might not be covered by Medicare. Understanding these potential limitations could help you avoid any unexpected out-of-pocket costs.
Preventive chiropractic visits, intended to prevent illnesses or disorders, may not be covered by Medicare. This could align with Medicare’s focus on specific doctors’ services, outpatient care, and medical supplies. Moreover, Medicare may exclude alternative treatments such as massage therapy and acupuncture, which may be sometimes provided by chiropractors as part of their services.
Preventive Visits and Alternative Treatments
The absence of Medicare coverage for preventive chiropractic visits might seem paradoxical, especially since prevention is a cornerstone of healthcare.
However, Medicare has specific rules and regulations that govern its coverage. For chiropractic care, Medicare’s coverage will likely limited to only cover manual manipulation of the spine for the correction of a subluxation.
It should also be highlighted that Medicare might not offer coverage for alternative treatments such as massage therapy and acupuncture. Although these services could be beneficial, they don’t meet the ‘medically necessary’ criteria under Medicare’s stipulations for chiropractic care. As such, they will likely not be included in Medicare’s coverage for chiropractic care.
The Role of X-rays and Diagnostic Tests
Another aspect to consider may be the role of X-rays and diagnostic tests in chiropractic care. You might wonder why these tests, which are commonly used in medical treatments, may be excluded from Medicare coverage when ordered by a chiropractor.
This may be due to Medicare’s restriction of chiropractic coverage to manual manipulation of the spine for subluxation correction, without encompassing additional diagnostics or treatments.
In essence, Medicare does not provide any exceptions for the coverage of X-rays and diagnostic tests ordered by chiropractors. This could include the CPT 98943 code for chiropractic treatments to extraspinal regions and any diagnostic tests prescribed by chiropractors, such as X-rays, for the treatment of spinal subluxation.
The Possible Costs of Chiropractic Care with Medicare
Understanding the costs that may be associated with chiropractic care under Medicare is just as important as the coverage. There are three primary cost-related aspects to consider: the annual Part B deductible, the coinsurance payment, and the Medicare-approved amount for chiropractic care.
Once the annual deductible for Medicare Part B has been met, Medicare begins providing coverage for these services. Once the deductible is met, individuals might be accountable for at least 20 percent of coinsurance payment for chiropractic care under Medicare.
Medicare Part B may then cover the remaining 80 percent of the Medicare-approved amount. This approved amount will likely be determined by the Physician Fee Schedule, which considers the maximum therapeutic benefit achievable for a given condition.
Meeting the Deductible
The annual Part B deductible for Medicare is an important aspect of understanding your potential costs. This deductible must be met before Medicare begins providing coverage for chiropractic services.
Virtually any item or service covered by Medicare Part B could be considered in meet the deductible, which may include medicare coverage for:
- Clinical research
- Ambulance services
- Durable medical equipment (DME)
- Mental health services
- Inpatient and outpatient services
Not all chiropractic services count towards fulfilling the Medicare Part B deductible. The specific benefits may vary depending on your plan.
Under Part B of Original Medicare, at least 80% of your covered chiropractic treatment could be paid after the deductible is met, and you will likely be accountable for the remaining 20% of the cost.
Coinsurance and Medicare-Approved Amounts
In addition to the deductible, another important term to understand is coinsurance. Within the context of Medicare, this could represent a proportion of the Medicare-approved sum that individuals may be responsible for paying for services after fulfilling any deductibles. The coinsurance percentage for chiropractic care may fluctuate based on the medical insurance plan and the specific services availed.
The term ‘Medicare-approved amounts’ with chiropractic services will likely denote the amount determined by Medicare as reasonable for a specific chiropractic service. Medicare could provide coverage for medically necessary spinal manipulation to correct acute or chronic subluxation, but might not extend coverage to other services or tests ordered by a chiropractor, such as X-rays, massage therapy, and acupuncture.
Medicare Advantage Plans and Chiropractic Benefits
Medicare Advantage plans may provide enhanced benefits for chiropractic care. As an alternative to traditional Medicare, these plans could offer extended coverage for services not included in the original Medicare, such as preventive visits and alternative treatments. However, bear in mind that the degree of coverage may vary among plans.
Some Medicare Advantage plans may include additional coverage for chiropractic services. This Medicare might cover certain chiropractic benefits for individuals who seek chiropractic care within their plan network. However, while some plans may cover some or all of the costs for chiropractic services, the extent of coverage may differ based on the individual and the provider.
Some of these Medicare Advantage plans may be required to provide coverage for at least the same chiropractic services as original Medicare, but there may be variations in copayments and deductibles. So, it’s essential to understand if your specific plan includes medicare cover chiropractic services.
Comparing Medicare Advantage Plans
When evaluating Medicare Advantage Plans, it is important to consider potential factors such as:
- Network coverage
- Prescription drug coverage
- Costs
- Extra benefits
- Quality of care
- Travel coverage
- Coverage rules
Additionally, it may also be advisable to understand the potential limitations of chiropractic care under Medicare Part B and the specific terms of each plan.
Some of the Medicare Advantage plans may provide coverage for chiropractic treatments, with the specifics varying for each plan member. While Part B could cover spinal manipulation for active treatment, some Advantage plans may have the potential to broaden this coverage.
How to Find a Plan That Covers Chiropractic Care
Finding a Medicare Advantage plan that could offer chiropractic coverage will likely require some research and comparison. You may use various online tools, such as the Medicare Plan Finder on this website to compare Medicare Advantage plans for chiropractic coverage.
To do so, just enter your zip code into any of the zip code boxes on this page. You can:
- Compare different Medicare Advantage and Prescription Drug Plans
- Focus on drug coverage and costs to find the perfect fit for your healthcare needs
- Input your information and sort through a variety of plans
- Weigh the pros and cons of each based on your situation
When comparing Medicare Advantage plans for chiropractic coverage, one should take into account possible factors, such as:
- The options available in their area
- The costs that may be associated with the plan
- The coverage details, including whether routine or maintenance chiropractic care is included
It’s important to note that the coverage specifics of Medicare Advantage plans often change, so it’s recommended to check the current details with your medicare advantage plan directly for accuracy.
Seeking Chiropractic Care: The Importance of a Primary Care Provider
Your primary care provider will likely play a crucial role in your journey toward chiropractic care under Medicare. Not only do they refer patients to chiropractors, but they could also coordinate their overall healthcare. This close relationship between your primary care provider and your chiropractor could significantly enhance your healthcare experience.
Your primary care provider will likely assess the medical necessity of chiropractic treatments for a Medicare patient by evaluating whether the patient has a spinal subluxation, which may be determined through a doctor’s exam or an X-ray.
One should note that a primary care provider might not issue a referral for chiropractic care, considering that Medicare patients usually don’t need a referral to consult a chiropractor. However, the decision to accept Medicare patients rests solely with the chiropractor.
Referrals and Medically Necessary Treatments
For Medicare to cover chiropractic care, the following requirements must be met:
- A referral from your primary care provider for medically necessary treatment is required.
- The treatment must be essential for diagnosing or addressing an illness, injury, condition, or disease and its symptoms.
- The treatment must adhere to established medical standards.
The required documentation for Medicare to cover chiropractic care includes:
- Evidence of spinal subluxation through x-ray or physical examination
- CT scan or MRI if necessary
- Documentation validating the necessity of manual manipulation
- Patient’s medical history and treatment details
It is noteworthy that a renewal for ongoing chiropractic treatments under Medicare might not be needed once a referral is obtained.
Communicating with Your Primary Care Provider
Maintaining open communication with your primary care provider could be essential in ensuring you receive the appropriate chiropractic care covered by Medicare. Discussing its potential benefits, sharing personal experiences, and highlighting the demonstrated effectiveness and safety of chiropractic treatments may facilitate this process.
When contemplating chiropractic care covered by Medicare, some questions you might want to ask your primary care provider may include:
- Understanding the rationale behind their recommendation of chiropractic care
- The extent of coverage provided by Medicare for such treatment
- The criteria for medical necessity to ascertain comprehensive coverage.
Chiropractic Care as an Alternative to Opioids for Chronic Pain
In recent years, there has been a growing body of evidence supporting the effectiveness of chiropractic care as an alternative to opioids for chronic pain management.
Chiropractic care will likely be recommended over opioid prescriptions for chronic pain relief and has demonstrated efficacy in reducing the use of opioids for conditions such as back pain, neck pain, headaches, and other musculoskeletal pain.
It is also noteworthy that Medicare might provide coverage for other non-opioid pain management alternatives, including acupuncture for chronic low back pain and physical therapy for a variety of conditions. This could offer patients more options for non-drug pain management.
The Impact of Chiropractic Care on Chronic Low Back Pain
Chronic low back pain is a common ailment that affects many people. Chiropractic care has been shown to have a positive impact on this condition. Chiropractic care has been suggested as the primary approach for managing chronic spinal pain instead of prescribing opioids.
It has been linked to reduced opioid usage in both the short and long term, and could potentially lead to moderate short-term enhancements in low back pain.
Chiropractors utilize techniques such as:
- Spinal manipulation
- Exercise advice
- Self-care strategies
- Massage
- Heat therapy
- Electrical stimulation
They may also address factors such as nutrition, stress, and exercise when treating chronic low back pain. These treatments have demonstrated a beneficial impact on pain intensity, disability, and function in individuals experiencing chronic low back pain.
Moreover, they could be regarded as a cost-effective substitute for long-term low back pain compared to physical therapy.
Medicare’s Coverage of Acupuncture and Physical Therapy
In addition to chiropractic care, Medicare may also cover acupuncture for chronic low back pain. This coverage follows section 1862(a)(1)(A) of the Social Security Act. It allows for up to 12 acupuncture visits within a 90-day period, with the possibility of an additional 8 sessions covered if there is demonstrable improvement.
Physical therapy for a range of chronic pain conditions may also be covered by Medicare. This could offer additional non-opioid pain management options for patients. The comprehensive details regarding coverage for occupational and physical therapy may be accessed on the official Medicare website.
Summary
This article has explored Medicare’s coverage for chiropractic care, understanding the nuances of what is covered and what isn’t.
While Medicare might cover chiropractic care for spinal subluxation through manual manipulation, it may not extend to preventive visits, alternative treatments, or X-rays and diagnostic tests ordered by chiropractors. The potential costs of chiropractic care under Medicare will likely include meeting the deductible, paying up to 20% coinsurance, and covering the Medicare-approved amount.
Some of the Medicare Advantage plans may offer additional chiropractic benefits and how to find a plan that suits your needs. This could emphasize the importance of your primary care provider in accessing chiropractic care and the role they play in providing referrals and ensuring treatments are medically necessary.
Lastly, this article has highlighted how chiropractic care could serve as an alternative to opioids for managing chronic pain, and other non-opioid pain management options covered by Medicare, such as acupuncture and physical therapy.
Frequently Asked Questions
→ How many chiropractic adjustments does Medicare cover per year?
Medicare might not have a limit on the number of covered chiropractic visits, but each visit must be deemed medically necessary for spinal manipulation to correct a subluxation.
→ When was chiropractic first included in Medicare?
Chiropractic care was first included in Medicare in 1972. Since then, efforts have continued to expand the services that chiropractors could provide to Medicare beneficiaries.
→ What does chiropractic care entail, and does Medicare cover it?
Yes, chiropractic care might include soft tissue therapy and joint manipulation to address issues related to bones, nerves, muscles, tendons, and ligaments, and Medicare may also cover chiropractic services specifically for spinal subluxation through manual manipulation.
→ Does Medicare cover ongoing or maintenance chiropractic care?
No, Medicare might not cover ongoing or maintenance chiropractic care once the spine is realigned.
→ What chiropractic services are not covered by Medicare?
Medicare might not cover preventive chiropractic visits, alternative treatments, or X-rays and diagnostic tests ordered by chiropractors. This may include services like massage therapy and acupuncture as well.
ZRN Health & Financial Services, LLC, a Texas limited liability company
Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.