Are Chiropractic Services Covered under Medicare ?
Medicare Part B pays for a chiropractor’s manual manipulation of the spine to correct a subluxation. Additionally, manual devices (for example: those that are hand-held with the device being controlled by hand) may be used by chiropractors in performing manipulation of the spine. However, no additional payment is allowed for the use of the device.
Medicare does not cover the following services performed by a chiropractor:
Initial physical examinations
Vitamin, mineral and/or food supplements, or other supplies
Chiropractic treatment is covered by Medicare if: You have a health problem in the form of a neuro-musculoskeletal condition that needs treatment (such as pain, inflammation, swelling, leg and foot numbness, etc.) You have a subluxation of the spine and manual manipulation has been recommended for improvement of your condition
What You Will Need To Pay?
You will have to pay the Part B deductible, and then 20% of the Medicare-approved amount. Many traditional medicare supplemental insurance plans will pay both the deductible and the co-insurance of 20 percent. Medicare reimbursement will be limited to one visit per day, unless there is a medical need for more than one treatment each day. The hands-on nature of chiropractic treatment requires patients to visit the chiropractor a number of times, often 3-4 times per week. A chiropractor may provide acute, chronic, and/or preventive care thus making a certain number of visits sometimes necessary. Each visit must be medically necessary and enhance your condition. Once further improvement cannot reasonably be expected from continuous ongoing care, the treatment is considered supportive/preventive, and Medicare will stop paying for treatment.
Do your homework before choosing a provider of chiropractic services. Ask the provider:
If they are a participating provider for Medicare
If they accept assignment of benefits from Medicare
To write down what they will charge and how much of it you will have to pay
If the chiropractor does not accept assignment: You may have to pay more than the Medicare-approved amount, usually 15% more. You may have to pay the entire cost of your services at the time they are performed. You may have to bill Medicare yourself and wait several weeks before you will be reimbursed. If the chiropractor does not participate in Medicare, Medicare will not pay the claim. You must have paid your annual deductible for services and supplies before Medicare will begin to pay its share unless you have the right kind of medicare supplement plan. You may pay little or nothing if you are covered by a Medigap/Medicare Supplemental Insurance plan. Medicare Advantage plans often do not cover chiropractic or may require a co-pay. Also, many chiropractors do not participate in medicare advantage plans. Call the plan or the agent who signed you up and ask about your share of cost.