Medicare coverage of chiropractic care is limited. Medicare only covers chiropractic manipulations of the spine when it meets Medicare’s specific rules.
All services that are not covered include:
- Office visits – examinations
- Physiotherapy – such as massage, manual therapy
- Non-spinal manipulation to the shoulder, arm, leg, etc
- Maintenance and Wellness Care
You are financially responsible for all services not covered by Medicare. You are also responsible for applicable annual deductibles or co-payments.
Medicare does not cover Maintenance Therapy for your spinal joint problems. You must have a significant health problem in the form of a neuromusculoskeletal condition necessitating treatment, and the manipulative services rendered must have a direct therapeutic relationship to the patient’s condition and provide reasonable expectation of recovery or improvement or function.
Maintenance Therapy includes services that seek to prevent disease, promote health and prolong and enhance the 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 in nature, the treatment is then considered maintenance therapy.
When you have an acute condition (e.g. injury or re-injury), or a chronic condition that needs rehabilitation, it is covered by Medicare. However, Medicare does not cover Maintenance Therapy for keeping you well after you are stabilized.
NOTE ON MEDICARE SUPPLEMENT PLANS: If a Medicare supplement plan follows ‘Medicare Guidelines’, this means that any services not paid by Medicare will not be paid by the Medicare Supplement Policy. If you have any questions on your supplement policy, please contact your insurance company.