Medicare covers chiropractic care, but the coverage comes with some very specific strings attached.
If you are a chiropractor treating Medicare patients or a practice manager handling the billing side, you need to know exactly what those strings are.
Getting this wrong leads to claim denials, frustrated patients, and a compliance headache nobody wants.
Many chiropractic practices assume that Medicare covers all the same services that private insurance covers. That assumption costs real money.
What Medicare Covers for Chiropractic Care?
The short answer is Medicare Part B covers manual manipulation of the spine performed by a licensed chiropractor, but only when the treatment is medically necessary to correct a subluxation.
A subluxation, in Medicare terms, means your spine is out of proper alignment and affects how your nervous system works. The chiropractor must demonstrate through physical examination or X-ray that this condition actually exists. Without that documentation, Medicare will not pay.
Here is the coverage requirements laid out clearly:
- Treatment must be for a subluxation of the spine. Not the shoulder. Not the hip. The spine.
- A licensed chiropractor must provide the service. Medicare does not cover chiropractic services from physical therapists or other providers.
- The treatment must be medically necessary. Every single visit needs to show active treatment, not maintenance care.
- The patient must meet the Medicare Part B deductible. For 2026, that deductible is $283.
One more thing that surprises many providers. Chiropractors are considered physicians under Medicare Part B, but only for the specific purpose of performing manual manipulation of the spine to correct a subluxation. That means for everything else a chiropractor might do, Medicare does not recognize them as a physician.
What Medicare Does Not Cover?
The list of non-covered services is longer than the list of covered ones. But, as a chiropractor, you must know this, because these are the services that get practices into trouble when patients assume everything is covered.
- X-rays taken by a chiropractor. Medicare does not pay for X-rays or any other diagnostic tests when a chiropractor orders or performs them. That includes X-rays, MRIs, and CT scans. However, if a medical doctor or osteopath orders those same X-rays, Medicare will cover them. The same image, ordered by a different provider type, changes the coverage outcome completely.
- Massage therapy. Not covered under Original Medicare when performed by a chiropractor.
- Acupuncture. Not covered when performed by a chiropractor.
- Physical therapy. Medicare covers physical therapy, but not when provided by a chiropractor. The patient would need to see a Medicare-approved physical therapist.
- Nutritional counseling. Not covered.
- Wellness or maintenance care. This is the biggest one. Once a patient reaches a clinical plateau where no further improvement is expected, continued treatment is considered maintenance therapy, and Medicare will not pay.
- Treatment for conditions other than spinal subluxation. Medicare covers chiropractic manipulation only for subluxation of the spine. Back pain alone is not enough. The documentation must show the subluxation.
- Extraspinal regions. Medicare does not cover chiropractic treatment to areas outside the spine. That means no manipulation of the head, temporomandibular joint, lower extremities, upper extremities, rib cage, or abdomen.
Remember, a chiropractor can treat a patient’s shoulder or hip, but Medicare will not pay for it. The patient would be responsible for those charges directly.
The Chiropractic Care Cost in 2026
Medicare Part B pays 80 percent of the approved amount for covered chiropractic services. The patient pays the remaining 20 percent as coinsurance, plus any unmet annual deductible.
For 2026, the Medicare Part B deductible is $283. Once the patient meets that deductible, Medicare pays its share of approved charges.
For example, a chiropractic manipulative treatment of 3 to 4 spinal regions, the average Medicare allowed amount is around $39. Medicare pays approximately $26, and the patient pays about $13 as their 20 percent coinsurance.
For 5 spinal regions, the average allowed amount is around $51. Medicare pays approximately $34, and the patient pays about $17.
These amounts are averages. Actual payments vary by geographic location and specific Medicare administrative contractor, but they give you a ballpark for patient conversations.
If a chiropractor does not accept Medicare assignment, the patient might pay more than the standard coinsurance amount. Most chiropractors who treat Medicare patients choose to accept assignment to avoid this complication.
The P.A.R.T. System for Documenting Subluxation
Medicare requires proof that a subluxation exists. That proof can come from X-ray or a physical examination. For physical exam documentation, Medicare recommends the P.A.R.T. system.
P.A.R.T. stands for Pain, Asymmetry, Range of motion, and Tissue tone changes. To document a subluxation through physical exam alone, the chiropractor must record at least two of these four components. And here is the critical rule: one of those two must be either Asymmetry or Range of motion abnormality.
P for Pain or Tenderness
This includes evaluating the perception of pain in terms of location, quality, and intensity. Most neuromusculoskeletal disorders manifest with a painful response. The provider can show pain through observation, percussion, palpation, or provocation. Pain intensity can be assessed using visual analog scales, algometers, or pain questionnaires.
A for Asymmetry or Misalignment
This shows asymmetry on a sectional or segmental level through observation, static palpation for misalignment of vertebral segments, or diagnostic imaging.
R for Range of Motion Abnormality
This shows changes in active, passive, and accessory joint movements. The provider can demonstrate range of motion abnormalities through motion palpation, observation, stress diagnostic imaging, range of motion measurements, or other measurements.
T for Tissue Tone, Texture, and Temperature Abnormality
This shows changes in the characteristics of contiguous and associated soft tissue, including skin, fascia, muscle, and ligament. The provider can demonstrate this through observation, palpation, use of instrumentation, or tests of length and strength.
Documenting at least two of these four, with one being A or R, satisfies Medicare’s requirement for demonstrating subluxation without an X-ray.
Initial Visit Documentation Requirements
The first visit sets the foundation for everything that follows. Medicare has specific expectations for what must be in that initial record.
Patient History
The record must include the chief complaint, including the symptoms causing the patient to seek treatment. Relevant family history and past medical history covering general health, prior illness, injuries, hospitalizations, medications, and surgical history are also required.
Present Illness
This description must include the mechanism of trauma, quality and character of symptoms or problems, onset, duration, intensity, frequency, location, and radiation of symptoms, aggravating or relieving factors, and prior interventions, treatments, medications, and secondary complaints.
Here is a warning from CMS. The symptoms must relate to the level of subluxation the chiropractor cites. A simple statement of pain on a claim is insufficient. The provider must describe the pain location and confirm that the vertebra listed can actually produce pain in that area.
Physical Examination
This is where the P.A.R.T. criteria come in. The exam must support the subluxation diagnosis with objective, measurable findings.
Diagnosis
The primary diagnosis must be subluxation and must include the level, either stated or identified by a term describing subluxation. The chiropractor must specify the precise level of subluxation. That means listing the exact bones, such as C5 or C6, or identifying the area if it involves only certain bones, such as occipito-atlantal or lumbo-sacral.
Treatment Plan
The plan must include the recommended level of care, including visit duration and frequency, specific treatment goals, objective measures to evaluate treatment effectiveness, and the date of the first treatment.
A simple note that says “patient has back pain” with no subluxation level and no treatment plan will be denied every single time. The specificity matters.
Subsequent Visit Documentation Requirements
Follow-up visits are not exempt from documentation requirements. Medicare expects to see certain elements every time.
The history portion should include a review of the chief complaint, any changes since the last visit, and a systems review if relevant.
The physical exam should cover the spine area involved in the diagnosis, an assessment of change in the patient’s condition since the last visit, and an evaluation of treatment effectiveness.
The note should clearly show whether the patient is improving, staying the same, or getting worse. If the patient has reached a plateau with no further improvement expected, that visit should not be billed to Medicare. That is maintenance care, and it is not covered.
Acute Subluxation Versus Chronic Subluxation Versus Maintenance
Medicare recognizes different categories of spinal joint problems, and the distinction matters for coverage.
Acute subluxation
A patient’s condition is considered acute when they are being treated for a new injury identified by X-ray or physical exam. The result of chiropractic manipulation is expected to be an improvement in or arrest of the progression of the patient’s condition.
Chronic subluxation
A patient’s condition is considered chronic when it is not expected to improve or be resolved with further treatment, as is the case with an acute condition. Still, continued therapy can be expected to result in some functional improvement.
Maintenance therapy
Once the clinical status of a given condition has remained stable without expectation of further objective clinical improvement, further manipulative treatment is considered maintenance therapy. Medicare does not cover maintenance therapy.
Maintenance therapy includes services that seek to prevent disease, promote health, prolong and enhance quality of life, or maintain or prevent deterioration of a chronic condition. When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the chiropractic treatment becomes supportive rather than corrective, the treatment is then considered maintenance therapy.
An acute exacerbation is a temporary but marked deterioration of the patient’s condition that causes significant interference with activities of daily living due to an acute flare-up of a previously treated condition. The clinical record must specify the date of occurrence, nature of the onset, or other pertinent factors that would support the medical necessity of treatment.
CPT Codes and Modifiers for Chiropractic Services
Using the right codes matters. Here are the primary CPT codes for chiropractic manipulative treatment.
- 98940 is for chiropractic manipulative treatment of 1 to 2 spinal regions.
- 98941 is for chiropractic manipulative treatment of 3 to 4 spinal regions.
- 98942 is for chiropractic manipulative treatment of 5 spinal regions.
- There are five spinal regions recognized: cervical region, including the atlanto-occipital joint; thoracic region, including costovertebral and costotransverse joints; lumbar region; pelvic region, including the sacroiliac joint; and sacral region.
- 98943 is for chiropractic manipulative treatment to extraspinal regions. Medicare does not cover this code at all.
- The AT Modifier. This modifier is required for Medicare to pay CPT codes 98940, 98941, and 98942. The AT modifier tells Medicare that the provider is delivering active treatment, which is care aimed at improving the patient’s condition, not just maintaining their current health.
- Do not use the AT modifier for maintenance therapy. Do not assume that the AT modifier alone proves medical necessity. The notes still need to show the subluxation, related symptoms, treatment plan, and the patient’s progress.
- The GA Modifier. This modifier is used for visits where the patient has signed an Advanced Beneficiary Notice, or ABN. The ABN lets the patient know that Medicare may not cover the service, and they could be responsible for the bill.
Same Day E/M and Adjustment
Some visits require both an evaluation and management service and a chiropractic adjustment on the same day. This is allowed but comes with scrutiny.
Medicare looks for two things when this happens.
- First, was there a separate, significant evaluation beyond what is usually done before an adjustment?
- Second, did the visit meet the criteria for the E/M level that was billed?
The notes must make this clear. When billing an E/M on the same day as a manual adjustment, the notes should read like two separate pieces of work, not one blended block. That is what auditors look for when deciding if a separate E/M is justified.
The Proposed Expansion of Coverage
There is legislation that could change chiropractic coverage under Medicare, but it has not passed yet.
The Chiropractic Medicare Coverage Modernization Act of 2025, also known as H.R. 538 and S.106, would broaden the range of covered services beyond just spinal manipulation. If passed, this law would allow Medicare to cover more of the services chiropractors commonly provide.
However, this bill has not become law as of 2026. Providers should base their decisions on current coverage rules rather than potential future changes.
How to Find a Medicare Participating Chiropractor?
For providers who want to treat Medicare patients, enrollment is required.
The Medicare.gov provider directory helps patients find participating chiropractors in their area. For chiropractors themselves, enrolling as a Medicare provider follows the standard Medicare enrollment process through the Provider Enrollment, Chain, and Ownership System, or PECOS.
Here is the bottom line for providers. If you want to treat Medicare patients and get paid by Medicare, you need to be enrolled. You need to accept the assignment. You need to document every visit using the P.A.R.T. criteria. And you need to know the difference between active treatment and maintenance care.
FAQs
How many chiropractic visits does Medicare cover per year?
Medicare does not limit the number of chiropractic visits per year. However, every single visit must be medically necessary to treat a spinal subluxation. The chiropractor must document the ongoing need for treatment at each visit. Once the patient reaches a plateau with no further improvement expected, Medicare stops covering additional visits because the care becomes maintenance therapy.
Does Medicare cover X-rays taken by a chiropractor?
No, Medicare does not cover X-rays or any other diagnostic tests when performed or ordered by a chiropractor. However, those same X-rays would be covered if ordered by a medical doctor or osteopath. The coverage depends on who orders the test, not just what the test is.
Will Medicare cover physical therapy provided by a chiropractor?
No, Medicare does not cover physical therapy services when provided by chiropractors. Medicare does cover physical therapy when it is medically necessary and provided by a Medicare-approved physical therapist or other qualified provider. If a patient needs physical therapy, they should see a Medicare approved physical therapist.
What happens if a patient sees a chiropractor who does not accept Medicare assignment?
If a chiropractor does not accept Medicare assignment, the patient might pay more than the standard coinsurance amount. The chiropractor can charge the patient up to 115 percent of the Medicare approved amount in most cases. Many chiropractors who treat Medicare patients choose to accept assignment to avoid this complication and make costs more predictable for patients.
Is maintenance care ever covered by Medicare?
No, maintenance therapy is not covered. Maintenance therapy includes services that seek to prevent disease, promote health, prolong and enhance quality of life, or maintain or prevent deterioration of a chronic condition. When further clinical improvement cannot reasonably be expected, and the treatment becomes supportive rather than corrective, Medicare does not pay.
Tired of Chiropractic Claims Denying Over Documentation Technicalities?
Missing AT modifiers, incomplete P.A.R.T. notes, maintenance-care visits billed as active treatment — these are the exact patterns that turn covered chiropractic services into denied claims and audit exposure. A2Z Medical Billing Services manages the full chiropractic revenue cycle: subluxation documentation review, correct CPT and modifier application, same-day E/M defense, and Medicare audit support.
Talk to an A2Z chiropractic billing specialist and find out where your current workflow is leaving money on the table.
