Does Medicare Cover Chiropractic Care?

Medicare is a federal program, so the rules below come from the Centers for Medicare & Medicaid Services (CMS) and apply to Medicare patients in New Jersey the same way they apply elsewhere [2]. The short version is that Medicare pays for one thing at a chiropractor's office.

Medicare.gov states that Part B "only covers adjustments of the spine by a chiropractor to correct a subluxation," when the chiropractor uses their hands or a device called an activator [1]. Medicare defines a subluxation in plain terms as a situation where the spinal joints fail to move properly, but the contact between the joints remains intact [1].

The federal regulation adds one more condition. Part B covers manual manipulation of the spine to correct a subluxation "if the subluxation has resulted in a neuromusculoskeletal condition for which manual manipulation is appropriate treatment" [3]. The chiropractor also has to be licensed in the state where the care is given, and the treatment has to be legal in that state [2].

Coverage is a payment rule, not a verdict on whether care helps. For new low back pain, the American College of Physicians' guideline lists spinal manipulation among non-drug options alongside superficial heat, massage and acupuncture [12]. The same guideline rates the evidence for manipulation as low quality and notes that most patients with acute or subacute low back pain improve over time regardless of treatment [12]. We think you deserve both halves of that sentence.

This is the part that surprises people. Medicare.gov says Medicare "doesn't cover other services or tests a chiropractor orders, including X-rays, massage therapy, and acupuncture" [1]. The CMS manual is broader: "All other services furnished or ordered by chiropractors are not covered" [2]. Under federal Medicare rules, that means the examination, any imaging the chiropractor takes or orders, and therapies other than the spinal adjustment itself are your cost, not Medicare's [2][3].

X-rays deserve a closer look. A chiropractor may use an X-ray to document a subluxation, but CMS states there is "no coverage or payment" for that X-ray or for any other diagnostic or therapeutic service ordered or furnished by the chiropractor [2]. An X-ray is also not the only way to document a subluxation for Medicare. CMS guidance for chiropractors accepts a physical examination showing at least two of four findings, known as P.A.R.T. (pain, asymmetry or misalignment, range-of-motion abnormality, and tissue or tone changes), as long as one of them is asymmetry or a range-of-motion abnormality [9].

So if imaging is suggested, it is reasonable to ask why it is clinically needed and what it will cost you, since Medicare will not pay for it when a chiropractor orders it [2].

For a covered adjustment, Medicare.gov says that after you meet the Part B deductible, "you pay 20% of the Medicare-approved amount" [1]. CMS set the 2026 Part B deductible at $283, up from $257 in 2025, and the standard Part B premium at $202.90 a month [4].

That 20% applies to covered adjustments. Anything outside the covered service, such as the exam or X-rays described above, is billed to you separately because Medicare does not pay for it [1][2].

The office's relationship with Medicare matters too. A provider who "accepts assignment" agrees to take the Medicare-approved amount as payment in full and to charge you only the deductible and coinsurance [8]. A provider who does not participate can charge more than the Medicare-approved amount, and in many cases that extra charge is capped at 15% above it, which Medicare calls the limiting charge [8]. Whether an office accepts assignment is worth asking before your first visit.

Medicare draws its main line between active care and maintenance care. CMS states: "Chiropractic maintenance therapy is not considered to be medically reasonable or necessary, and is therefore not payable" [2]. It defines maintenance therapy as treatment "performed to maintain or prevent deterioration of a chronic condition," and says that once further clinical improvement cannot reasonably be expected, care is supportive rather than corrective [2].

In billing terms, CMS tells chiropractors to mark a claim with an AT modifier when they provide active or corrective treatment for an acute or chronic subluxation, and not to use it for maintenance therapy [9]. That is a rule about how the claim is coded. It is not a statement about how you feel, and it is not a promise of any particular number of covered visits.

If a provider expects Medicare will not pay for a service, they may give you a written notice called an Advance Beneficiary Notice of Noncoverage, or ABN [7]. The ABN lists the services the provider expects Medicare will not cover, with an estimate of the cost [7]. You then choose: receive the service and have the claim sent to Medicare, receive it without a claim being sent, or decline it and not be responsible for paying for it [7].

Medicare scrutinizes this area closely. A 2016 audit by the HHS Office of Inspector General estimated that about 82% of the Medicare payments it reviewed for chiropractic services did not comply with Medicare requirements, and cited maintenance therapy as a central problem [10]. That is part of why careful offices document each visit in detail and use ABNs when coverage is in doubt.

Medigap. Medicare.gov describes Medicare Supplement Insurance (Medigap) as extra insurance from a private company that helps pay "your share of out-of-pocket costs in Original Medicare, like copayments, coinsurance, and deductibles" [5]. The exam, X-rays and therapies listed above are not Original Medicare costs, because Original Medicare does not cover them [1][2]. Check your own policy for what it pays toward a covered adjustment.

Medicare Advantage. Medicare Advantage plans "must cover all medically necessary services that Original Medicare covers," and may offer extra benefits Original Medicare does not [6]. Medicare.gov also notes you may need to use providers in the plan's network, may need a referral to see a specialist, and that out-of-pocket costs vary by plan [6]. You cannot buy a Medigap policy to cover Medicare Advantage costs [6]. If you have an Advantage plan, call the number on your card and ask three things: whether chiropractic visits need a referral or prior approval, whether a specific office is in network, and what your copay or coinsurance is.

Other insurance. Care after a motor vehicle accident is a separate coverage question, covered in our post on seeing a chiropractor after a car accident.

Hunterdon Back Pain Center sees adults across Clinton, NJ, Hunterdon County and Warren County, including people on Medicare. Before a first visit at any chiropractic office, these questions help avoid surprise bills:

• Do you accept Medicare assignment [8]?
• Which parts of today's visit will be billed to Medicare, and which will be billed to me [1][2]?
• If you recommend X-rays, what will they cost me [2]?
• Will you tell me, in writing, if you expect Medicare will not pay for a service [7]?

Our post on what to expect at a first visit walks through the visit itself, and our guide to chiropractic care for seniors covers how care is approached for older adults.

For help with coverage questions, New Jersey's State Health Insurance Assistance Program (SHIP) offers free help to New Jersey Medicare beneficiaries with questions about Medicare, claims and Medigap, through trained counselors, at 1-800-792-8820 [11]. Coverage rules can change, so confirm the current details with Medicare, your plan or SHIP before relying on them for your own situation.