What Does Medicare Cover For Chiropractic Care?
Does your back hurt? If you are on Medicare, you may wonder if Medicare pays for chiropractic care.
My first experience with chiropractic care was at 17. Medicare-covered chiropractic care had not even crossed my mind.
I was complaining to my dad that I woke up with pain in my back. He said I should go to a chiropractor. I didn’t know what that was. So he explained it was kind of a doctor that fixed backs. I asked if I should have mom set an appointment. He brushed it off. “Your mom doesn’t need to know about it.”
He sent me to a guy down on Vinton Street in South Omaha. Dad told me it would be $10. So I went. By myself. No mom.
My First Chiropractic Experience
The chiropractor’s office was different than any doctors’ office I had ever seen before. The people in the waiting room seemed like they were in their 100’s at the time. I was a junior at South High. As soon as I walked in, I heard someone scream from the doctor’s office. I almost ran out, but none of the old folks even turned their heads in the direction of the noise. I was beginning to think this was one of my dad’s pranks.
When my turn came, I got up and went into the chiropractor’s office. The doc was about one day younger than God. He told me to lie face down on a strange-looking table. He quickly stepped over to me and pushed down hard on my back, and the table under me made a loud sound that startled me. Before I could say anything, he had whacked me a few more times, made a bunch of noise, and then said, “$10, please.”
I stood up and walked out, still in a semi-state of shock. As I stepped out on Vinton Street, I realized my back felt great!
Medicare DOES cover chiropractic services.
Does Medicare Cover Chiropractic Care?
If I had been on Medicare at the time, Medicare Part B would have covered that chiropractic procedure ( Part A does not) because it was a spinal manipulation or subluxation. That is the only thing that Medicare covers among the assortment of services chiropractors offer.
Subluxation falls under Medicare Part B for doctor and outpatient services. The Part B deductible would apply to spinal manipulation. Then the client would pay the 20% coinsurance. Medicare Part B would pay the other 80%.
Check Your Insurance Before You Go
If you have other insurance, such as a Medicare Supplement, the supplement will fill the gap as determined by the type of plan, e.g., Plan G, Plan N, etc. If you have an employer health plan with your Medicare Part B, that may also fill some of the cost.
This all, of course, assumes the chiropractor takes assignment for Medicare. If he does not accept Medicare billing and payment as sufficient, the whole procedure will be out of your pocket.
What Does Medicare NOT Cover for Chiropractic Care?
The list of chiropractic services not covered by Medicare is much longer than the list of covered items.
- Laboratory tests
- Office Visits (history and physical)
- Diagnostic studies, including EKGs
- Orthopedic devices
- Nutritional supplements and counseling
The key is that Medicare will not pay for these chiropractic services if they are ordered by a chiropractor. The chiropractor may use the information from such tests that other medical doctors ordered and performed but cannot order the procedures himself on Medicare’s dime.
What Does Medicare Advantage Cover for Chiropractic Services?
Medicare Advantage is Medicare but administered by a private insurance company. The private insurance company may offer additional benefits that Original Medicare does not ordinarily cover. The richness of the plan depends on the size, location, and star rating, but some of the additional benefits are vision, dental, gym membership, and additional chiropractic services that Original Medicare does not pay for.
Check the Evidence of Coverage
You will want to read the Evidence of Coverage provided with each plan to know exactly what chiropractic services are covered by your Medicare Advantage plan. Those additional benefits can change from year to year because they are not essential parts of Medicare but “additional” benefits. Those changes could happen for several reasons and will be announced before the new plan year starts so beneficiaries may make appropriate adjustments in their Medicare planning. Some of the Advantage plans in our area are very flexible and generous with chiropractic care.
Some of the plans in our Omaha, Lincoln, Council Bluffs Metro areas include acupuncture, massage therapy, and traction as part of what a chiropractor may bill the Medicare plan for beneficiaries. For those who regularly use chiropractic care, this is a significant savings and benefit to them.
Will Medicare Coverage of Chiropractic Services Expand Soon?
The American Chiropractic Association ACA is working to increase Medicare coverage of chiropractic services. The following bill has been introduced in the U.S. House of Representatives:
“The Chiropractic Medicare Coverage Modernization Act (H.R. 2654) would allow Medicare beneficiaries access to the chiropractic profession’s broad-based, non-drug approach to pain management, which includes manual manipulation of the spine and extremities, evaluation and management services, diagnostic imaging, and utilization of other non-drug approaches that have become an essential strategy in national efforts to stem the epidemic of prescription opioid overuse and abuse.”
H.R. 2654 also:
- Provides patient access to all Medicare-covered benefits allowable under a chiropractor’s state licensure.
- Requires that D.C.s complete a documentation webinar.
- Appropriately defines a Doctor of Chiropractic (D.C.) as a “physician” in the Medicare program.
- It is bipartisan legislation introduced by 16 cosponsors from both political parties.
The redefinition of doctors of chiropractic as “physicians” opens a whole world of issues that the carefully coached language of the bill can not hide or subdue.
For M.D.s and D.O.s, Medicare will pay for any covered service. Coverage for chiropractic services is limited only to treatment utilizing manual manipulation of the spine to correct a subluxation.
This translates into just 3 of the 15,000 procedure codes used to bill Medicare. Chiropractors don’t like this; hence they want “parity” with M.D. and D.O. physicians and the ability to bill Medicare for any service that is within their expansive scope of practice.
Long-Standing Battle Between DC’s & MD’s
Congress authorized limited Medicare coverage of chiropractic services in the early 1970s over objections of the Department of Health, Education, and Welfare. Regulations further limit coverage to neuromusculoskeletal conditions for which manipulation is an appropriate treatment. Since its inception, chiropractors and the Department of Health and Human Services, whose Centers for Medicare and Medicaid Services (CMS) administers the Medicare program, have been locked in a near-continuous battle over claims submitted for “maintenance care,” a treatment plan that seeks to prevent disease, promote health, and prolong and enhance the quality of life, or therapy performed to maintain or prevent deterioration of a chronic condition.
Maintenance Care Is Not Covered But Paid
This so-called “maintenance care” (sometimes called “wellness care”) consists of regular “spinal checkups” for the detection and correction of “subluxations,” advertised by chiropractors as necessary to prevent health problems. There is no evidence that maintenance care is effective for this or anything else. It is not covered by Medicare, which hasn’t stopped chiropractors from submitting hundreds of millions of dollars in unauthorized claims. They are also notorious, as detailed in several HHS Office of the Inspector General reports, for failing to document their Medicare claims adequately.
This ongoing conflict is why H.R. 3654 contains a provision requiring chiropractors to take a course on documentation. Oddly, the documentation requirement does not apply if the chiropractor seeks Medicare payment for “manual manipulation of the spine to correct a subluxation,” the very portal through which they are paid millions of dollars for unauthorized treatment.
This change would result in hundreds of millions of more dollars billed to Medicare. It will be interesting to see how this controversy is settled or not in the next Congress.
As for now, Part B will cover spinal manipulation (subluxation), and Medicare Advantage will cover that as well as possibly more, depending upon the details of that particular plan. Read the Evidence of Coverage carefully.
I have found spinal manipulation essential to my pain-free well-being. However, I am not sure where I fall on expanding Medicare further and raising costs higher. The debate will be interesting to watch.
While that bill works its way through Congress, Medicare’s guidelines for chiropractic service remain as they have been. This means that Medicare does cover some chiropractic services, and your Medicare Advantage plan may pay for additional chiropractic care.
To learn more about your Medicare chiropractic coverage, including the benefits of the different Medicare Advantage plans available in your area, contact Omaha Insurance Solutions today at 402-614-3389 to speak with a licensed insurance agent professional.