MEDICARE CHIROPRACTIC POLICY
• If you are injured, have an exam related to that injury and are under a treatment plan for that
specific injury, Medicare will cover a portion of your adjustment. After that treatment plan, it is
not covered.
• If you are being treated for chronic pain, Medicare will not cover it.
• If you are being treated on a periodic basis, i.e. twice a month, once a month, every 3 weeks…,
this is considered maintenance and Medicare will not cover it.
• Medicare never covers exams, x-rays, therapy or massage.
• Secondary does not cover anything Medicare doesn’t cover. They will cover the other portion of
the medically necessary adjustment.
• You are charged for services in our office at the Medicare specified rate (this is government
mandated)
• You will be told on every visit whether we believe Medicare will consider your services as
medically necessary.
Chiropractic Coverage
Medicare only provides coverage for the chiropractic adjustment of the spine. Your coverage
usually includes a number of visits based on medical necessity.
Exams, X-rays, Massage therapy, orthotics and physical therapy coverage:
Medicare never covers these. Instead, you are responsible for payment of these services at a
reduced Medicare rate.
What if I have secondary insurance?
This entirely depends on your secondary plan. Most secondary insurance will still only consider
the chiropractic adjustment. They simply reimburse the portion of the adjustment that Medicare
does not. All other services are still not covered. A select few (very few) secondary plans will
cover those services that Medicare does not even consider.
We do not file with your secondary insurance, Medicare does. We file with Medicare. After
Medicare completes the processing of your claims, they will send the explanation to your secondary
insurance for consideration. Some secondary insurances pay us directly as we are providers with
them. When this occurs, a credit will be applied to your account.
Maintenance Therapy:
“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. Under the Medicare program, Chiropractic maintenance therapy is
not considered to be medically reasonable or necessary, and is therefore not payable”
“Maintenance/Palliative Care is not a covered benefit for any of our covered managed care plans.”