What Medicare Covers for Chiropractic Care When You Receive SSI

Medicare does not cover routine chiropractic care, but it does cover spinal manipulation for specific conditions

If you receive Supplemental Security Income (SSI) and have Medicare, your coverage for chiropractic services is limited. Medicare Part B covers spinal manipulation only when a doctor diagnoses a subluxation of the spine — a misalignment that causes nerve or muscle dysfunction. This is not the same as general chiropractic wellness visits or maintenance care.

The key word is "subluxation." Medicare will not pay for chiropractic adjustments for back pain, neck pain, or other conditions unless a physician or chiropractor documents that a vertebra is out of alignment and causing a specific medical problem. Even then, coverage is limited to a set number of visits per year.

Because SSI recipients often have limited income, understanding what Medicare will and will not cover matters directly to your out-of-pocket costs. If your chiropractor bills Medicare and Medicare denies the claim, you may be responsible for the full bill.

Key Takeaways

Medicare Part B covers spinal manipulation only when a doctor diagnoses a subluxation of the spine that is causing a medical problem.
Medicare does not cover routine chiropractic visits, wellness adjustments, or maintenance care.
Coverage is limited to a maximum number of visits per year, and your chiropractor must be enrolled in Medicare to bill directly.
If Medicare denies a claim, you are responsible for the bill unless your chiropractor agreed in writing to waive the charge.
Medicaid coverage for chiropractic care varies by state and may offer broader coverage than Medicare.

What "Subluxation" means and why it matters for coverage

A subluxation is a vertebra that has shifted out of its normal position and is interfering with nerve or muscle function. Medicare requires that a doctor — either a medical doctor, osteopath, or chiropractor — diagnose the subluxation and document that it is causing a specific medical condition. The diagnosis must appear in your medical record before the chiropractor performs the adjustment.

This is stricter than many people expect. Having back pain or neck stiffness is not enough. Having an X-ray that shows a vertebra slightly out of place is not enough. Medicare requires documentation that the misalignment is actually causing symptoms — pain, numbness, weakness, or loss of function — and that spinal manipulation is the appropriate treatment.

Your chiropractor should ask for this documentation from your doctor before treating you. If they do not, or if they proceed without it, Medicare will likely deny the claim and you will owe the full cost.

How many chiropractic visits Medicare will cover

Medicare Part B covers up to 12 chiropractic visits per year for spinal subluxation, though your doctor or chiropractor may request more visits if medically necessary. The visits must be for the same condition and must be documented as medically necessary in your medical record.

After 12 visits, your chiropractor can request additional coverage by submitting documentation to Medicare explaining why more visits are needed. Medicare will review the request, but approval is not may provide. Many requests for visits beyond 12 are denied.

Each visit counts toward your annual limit, so if you see a chiropractor in January and again in December, both visits use up your yearly allowance. Once you reach 12 visits, you pay out of pocket for any additional chiropractic care that year.

Whether your chiropractor is enrolled in Medicare

Not all chiropractors accept Medicare. Some are enrolled providers, meaning they have agreed to bill Medicare directly and accept Medicare's payment as full payment (except for your copay or coinsurance). Others are not enrolled and will ask you to pay upfront and submit the claim yourself, or they will not see Medicare patients at all.

Before making an appointment, ask your chiropractor whether they are a Medicare provider. If they are not, you can still see them, but you will pay the full bill and then submit a claim to Medicare yourself. Medicare will reimburse you only for the portion it covers — usually less than what the chiropractor charged.

You can search for Medicare-enrolled chiropractors in your area using the Medicare Provider Search tool on Medicare.gov. Enter your zip code and select "Chiropractor" as the provider type.

What happens if Medicare denies your claim

If your chiropractor bills Medicare and Medicare denies the claim, you have the right to appeal. However, you are not responsible for paying the bill while the appeal is pending if your chiropractor signed an Advance Beneficiary Notice (ABN) with you before treatment. An ABN is a form that tells you in advance that Medicare may not cover the service, and it gives you the choice to proceed anyway and accept responsibility for the cost.

If your chiropractor did not give you an ABN and Medicare denies the claim, the chiropractor cannot bill you for the denied service. They must write off the cost. This is called "balance billing protection," and it applies when a provider fails to notify you in advance that a service might not be covered.

If you believe Medicare made an error in denying your claim, you can file an appeal. Your chiropractor can help you with this, or you can contact Medicare directly at 1-800-MEDICARE.

Medicaid and other coverage options for SSI recipients

If you receive SSI, you likely also receive Medicaid in your state. Medicaid coverage for chiropractic care varies significantly by state. Some states cover chiropractic services more broadly than Medicare does — for example, covering treatment for general back pain, not just subluxation. Other states cover chiropractic care only in limited circumstances or not at all.

Contact your state Medicaid office or check your Medicaid handbook to learn what chiropractic services your state covers. If your state Medicaid covers chiropractic care and Medicare does not, you may be able to use Medicaid instead. If both programs cover the service, Medicaid typically pays first, and Medicare pays any remaining balance.

Some SSI recipients also have coverage through a former employer, a spouse's plan, or a private insurance plan. If you have multiple forms of coverage, tell your chiropractor about all of them so they can bill in the correct order.

Out-of-pocket costs and copays

If Medicare covers your chiropractic visit, you typically pay a copay of 20% of the Medicare-approved amount after you have met your Part B deductible. The deductible amount changes each year; for 2024, the Part B deductible is $240. Once you have paid $240 out of pocket for Part B services in a calendar year, Medicare covers 80% of approved services and you pay 20%.

If your chiropractor is not a Medicare provider or charges more than Medicare's approved amount, your out-of-pocket cost will be higher. Some chiropractors charge significantly more than Medicare allows, and you may owe the difference.

If cost is a barrier, ask your chiropractor about payment plans or sliding-scale fees. Some chiropractors offer reduced rates for patients with limited income. You can also contact your local Area Agency on Aging or a community health center to ask about low-cost chiropractic services in your area.

Frequently Asked Questions

Can I use Medicare to pay for a chiropractor to treat my arthritis or general back pain?

No. Medicare covers spinal manipulation only for subluxation — a vertebra out of alignment causing nerve or muscle dysfunction. General back pain, arthritis, or muscle strain are not covered, even if a chiropractor says they can help. Your state Medicaid program may cover these conditions, so check your Medicaid coverage first.

What if my doctor says I need chiropractic care but Medicare denies it?

Ask your doctor to document in your medical record that you have a subluxation of the spine and that spinal manipulation is medically necessary. Give this documentation to your chiropractor before your visit. If Medicare still denies the claim after this, you can appeal or ask your doctor to write a letter of medical necessity to submit with your appeal.

Do I have to use a Medicare-enrolled chiropractor?

No, but it is usually easier and cheaper. If you see a non-enrolled chiropractor, you pay upfront and submit the claim to Medicare yourself. You will likely receive less reimbursement than if you saw an enrolled provider, because non-enrolled providers can charge whatever they want and Medicare will only reimburse its approved amount.

If I have both Medicare and Medicaid, which one pays for chiropractic care?

It depends on your state's Medicaid rules. In most cases, Medicaid pays first if it covers the service, and Medicare pays any remaining balance. Contact your state Medicaid office to confirm what chiropractic services your state covers and in what order your programs will pay.

Can I appeal if Medicare denies my chiropractic claim?

Yes. You have the right to appeal any denied claim. Contact Medicare at 1-800-MEDICARE or ask your chiropractor to file the appeal on your behalf. Include any documentation from your doctor showing that you have a subluxation and that treatment is medically necessary.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.