Chiropractic services must be provided by doctors of chiropractic, also known as 'chiropractors' and 'chiropractic physicians'. These doctors perform 'spinal manipulation' or 'chiropractic adjustments.' Chiropractors must be licensed or legally authorized to perform chiropractic services in your state.
Medicare covers ‘manual manipulation’ of the spine to correct an acute ‘subluxation.’ ‘Subluxation’ means a partial dislocation of one or more bones in your spine. Your treatments must be addressing acute symptoms and not chronic illnesses.
When we say ‘manual manipulation,’ we mean the chiropractor is using his or her hands to perform the therapy. Medicare does allow a chiropractor to use a hand-held device, but it must be one they control by hand. Medicare can’t pay the doctor for having the device, and it won’t pay extra if the doctor chooses to use the device instead of using his or her hands.
All spinal dislocations have to be proven through an X-ray or a specific physical exam. No other testing or therapy is covered, and Medicare must be able to verify that the services are medically necessary and will give you a reasonable expectation of recovery or improvement.
If your chiropractor takes an X-ray or performs another kind of test to assess your condition, Medicare will not pay for the X-ray or any other diagnostic services. Instead, your doctor will use the results of these tests to determine a treatment plan.
If your doctor performs a physical exam, he or she will look for pain or tenderness, observable misalignments, your range of motion, and changes in the tissues around your spine.
Your doctor will ask you about your symptoms, family history, your past medical history, the severity of your symptoms, when the symptoms came on, for how long, and their intensity. Your doctor will ask you about factors that aggravate your condition and any treatments or medications you may have used to treat your pain.
Medicare may only pay for your doctor to treat acute problems and new injuries. He or she must develop a treatment plan that has specific goals that are expected to be achieved and objective measures that will be used to evaluate how effective the treatment is.
If your treatment changes from addressing an injury to maintaining or preventing future deterioration of your spine, then Medicare can no longer pay for these chiropractic services. Continued treatments that don’t have achievable, clearly defined goals would be considered ‘maintenance therapy.’
This means, there is no expectation of improvement but the doctor plans to continue treatments that keep you at the same level of health. Medicare does not cover maintenance therapy.
Medically necessary chiropractic services are covered by Medicare – you will only need to pay 20 percent of the Medicare-approved amount, and your Part B deductible will apply. You will be charged for any other services or tests (such as the X-rays and the physical exam used to evaluate your condition. Medicare also will not pay for massage therapy).