The Stanly News and Press (Albemarle, NC)

October 17, 2012

Insight on Medicare coverage for chiropractic

By Dr. Larry Bridge for the SNAP

Wednesday, October 17, 2012 — Many people with Medicare benefits would like to use the services of a chiropractor but are unsure of what is covered.  As everyone knows or has experienced, understanding how Medicare works and what is covered is like trying to understand someone who speaks a foreign language. You can usually pick up bits and pieces of what they are trying to say, but you never quite get the whole picture. So what exactly does Medicare cover in a chiropractic office?  A good question, that I will attempt to explain in a simplified manner.  

What Is Chiropractic?

Chiropractic is a hands-on, drug-free approach to restoring health. This usually includes an examination, x-rays (if deemed medically necessary), diagnosis, a care plan and treatment. Chiropractors perform spinal manipulations or adjustments to remove nerve interference (called a subluxation), restore motion to the joints, decrease pain and muscle tension to enable proper tissue healing and increase function and  mobility.

What Service Is Covered?

Currently chiropractic manipulative treatment (adjustments) to correct a subluxation is the only service that is covered by Medicare PART B in a chiropractors office. There are no caps or limits on the number of treatments received by a chiropractor and Medicare will pay for treatments it determines and can be shown by documentation to be “reasonable and medically necessary.” Some of the conditions covered include: headaches, neck or back pain, radiating pain or numbness/tingling in the arms or legs (sciatica).  Also covered are neuromusculoskeletal conditions that need treatment or a condition of  or relating to the spine where manual manipulation has been recommended for improvement of your condition.  

Treatment can be provided for acute and chronic conditions as long as each treatment is medically necessary and enhance or improve your condition. Multiple treatments are usually necessary and your chiropractor will recommend to you how long you need to treat to improve or enhance your condition. If chiropractic cannot improve your condition you will be referred to the proper medical provider.

What Service Is Not Covered?

Medicare does not cover your examination, x-rays, physical modalities such as electrical muscle stimulation, massage, acupuncture, traction, decompression, durable medical equipment, vitamins or supplements.  

Preventative, supportive or maintenance care is not covered by Medicare. Once you have met maximal medical improvement or  further improvement is not expected from continuing care your treatment is considered supportive or preventative and Medicare will not pay for treatment. In a nutshell, Medicare will pay to help you get  well, but will not pay to keep you well.