Craig W. Brue, Doctor of Chiropractic (D.C.)
Many patients have questions about the exact coverage that Medicare provides for a chiropractic visit. The simple fact about Medicare and chiropractic is this: Medicare covers chiropractic care differently than medical treatment. Medicare does provide coverage for spinal adjustments in a chiropractic office, but there are some restrictions on your coverage for treatment in a chiropractic office.
Medical necessity: For Medicare to cover spinal adjustments, the treatment must be “medically necessary.” These are the specific requirements for Medicare to cover your treatment in a chiropractic clinic.
1. Your adjustments must relate to a specific health complaint. Medicare will not pay for services when you feel “fine, good, pretty good, alright, or OK.” Medicare will not pay for care because you know it helps you “feel better.”
2. Your adjustments must hold the promise of making functional improvement. That means that adjustments must improve your ability to function (such as sleeping better, walking more, completing household activities, or bending more easily) because spinal adjustments reduce the level of pain and immobility.
3. You must follow your chiropractor’s specific plan for treatment. Coming into an office whenever you want an adjustment does not necessarily mean that you are under a doctor’s prescription plan for spinal care.
Maintenance and prevention care: The following is Medicare’s stated policy regarding the coverage of maintenance or preventive care in a chiropractic clinic.
1. “Any treatment plan that seeks to prevent disease, promote health, or prolong and enhance the quality of your life is NOT COVERED BY MEDICARE.” Treatment is considered maintenance therapy when chiropractic treatment is supportive and not corrective. (While this policy doesn’t make any common sense, it is the stated policy of Medicare. Medicare is willing to pay for prolonged drug care, but it will not pay for prevention or wellness care in a chiropractic office.)
2. “Treatment is considered maintenance therapy when chiropractic treatment is supportive and not corrective.” Medicare will not pay for care after you have reached maximum improvement.
3. “Any treatment that is ongoing and cannot be expected to result in further clinical or functional improvement is NOT COVERED BY MEDICARE.” Medicare has definite limits to the coverage for regular or periodic chiropractic care.
The following services are excluded from Medicare: Medicare will NOT pay for X-rays, examination, therapy, extremity adjustments, rehabilitative exercises, structural supports, or vitamin supplements. Medicare requires the doctor of chiropractic to document the need for care by examination or X-ray, but Medicare will NOT pay for the cost of any examination procedure. Supplemental insurance will typically cover Medicare deductibles and co-pays for adjustments.
If you have questions about your coverage for chiropractic visits, it is important that you understand the rules and regulations that affect your care, and the doctor and staff at any chiropractic clinic will be able to answer any questions you have.
Dr. Craig W. Brue is an author, lecturer, and chiropractic provider in SaddleBrooke.