Does Medicaid Cover Chiropractic Care? | HelpAdvisor.com (2024)

Doctors of chiropractic use manual techniques to correct spinal and joint problems and promote a healthy nervous system. You may be considering chiropractic treatment if you have a health condition affecting your joints or spine, such as subluxation.

Chiropractic care can be expensive, so knowing whether your health coverage includes chiropractic care before starting treatment is important. So, does Medicaid cover chiropractic care? Below, you can find out how Medicaid and Medicare coverage for chiropractic treatment works and who's eligible.

Does Medicaid Cover Chiropractic Care?

Whether Medicaid covers chiropractic care depends on which state you live in. Chiropractic treatment through Medicaid is non-mandatory, which means that each state can decide whether to include it in its coverage.

Twenty-four states cover chiropractic care as of 2018, and six states don't disclose whether their Medicare plans include chiropractic treatment. Of the covered states, 13 charge beneficiaries a small copayment up to $3.80 per session for chiropractic treatment.

Eighteen states place limits on the amount of chiropractic care funded through Medicaid, and limitations vary between states. For example, some states limit the number of visits funded per year while others place an annual funding cap on chiropractic treatment per enrollee.

Does Medicare Cover Chiropractic Care?

Medicare may cover medically necessary manual spinal manipulation by a chiropractor to treat subluxation, a condition where the vertebrae move out of their correct position. It doesn't cover other chiropractic treatments or associated tests, such as X-rays or massage. Medicare may cover acupuncture performed by a chiropractor for lower back pain as long as the practitioner is licensed.

If you're eligible, Medicare will usually pay 80% of the Medicare-approved amount for chiropractic care through Part B. Beneficiaries are liable to pay the remaining 20% and the Part B deductible. As of 2022, the Medicare Part B deductible is $233.

Your chiropractor may recommend other treatments not funded by Medicare or request tests such as X-rays before your treatment starts. In this situation, you are responsible for covering the costs of these treatments if you choose to proceed. You should ask your therapist to explain their rationale for recommending particular treatments and check if Medicare covers them before you start treatment.

Do Chiropractors Have to Bill Medicare?

Chiropractors must bill Medicare directly for any covered services performed. There is a common misconception that nonparticipating doctors of chiropractic don't need to bill Medicare. However, all doctors are obliged to bill Medicare whether they have signed an agreement to treat all eligible beneficiaries (participating doctors) or not.

How Many Chiropractic Sessions Does Medicare Cover?

There is no limit to how many chiropractic sessions Medicare will cover if you're eligible for funding, and funding caps are not permitted.

However, some Medicare Administrative Contractors (MACs) have policies that require a documentation review after a certain number of sessions. This has led to a misconception that Medicare will only cover 12 chiropractic sessions because many MACs automatically review funding after this period.

Doctors of chiropractic can appeal the MAC's decision if they feel that funding has been wrongfully withdrawn after a routine review. Doing so can help them secure reimbursem*nt and ensure that beneficiaries receive the treatment they are entitled to without paying out of pocket.

How Much Does Chiropractic Care Cost Out of Pocket?

How much chiropractic care costs out of pocket depends on several factors, including where you live and what treatment you require. Generally, you should expect to pay around $65 per session for spinal manipulation. However, prices range between $34 and $106, and you may be charged towards the upper end of the scale if you require complex treatment or diagnostic tests such as X-rays.