Yes, but only for one narrow service: a qualified chiropractor’s manual manipulation of the spine to correct a vertebral subluxation, billed under Medicare Part B. Everything else a typical chiropractic office offers, from X-rays to maintenance adjustments, falls outside the program, and the bills that arrive later often catch patients off guard.
Knowing the exact four CPT codes Medicare reimburses (98940 through 98943) is the fastest way to predict what your visit will cost before you lie down on the adjustment table.
This guide covers the narrow path Medicare carves out for chiropractic care, from the specific manual manipulation it reimburses under Part B to the four CPT codes that decide what shows up on your bill.
The Narrow Way Medicare Defines Covered Chiropractic Treatment
Medicare Part B treats spinal manipulation as a covered service only when a licensed chiropractor uses manual force to correct a vertebral subluxation, a misalignment of the spine that the Centers for Medicare & Medicaid Services recognizes as a treatable condition. Anything billed beyond that single clinical scenario lands outside the benefit.
The scope of that coverage is set by CMS National Coverage Determination 150.1, the federal rule that defines exactly when manipulation qualifies for payment. Active corrective care meets the standard. Maintenance therapy, defined as adjustments given after you have reached maximum therapeutic improvement, does not. The distinction matters because CMS reimburses the first and denies the second, even when the office visit feels identical to you.
The Four CPT Codes That Trigger Payment
Chiropractic offices bill spinal manipulation under a small family of CPT codes. Recognizing them on your Explanation of Benefits is the fastest way to confirm Medicare actually paid for your visit.
| CPT Code | Region Treated | Typical Use |
|---|---|---|
| 98940 | One to two spinal regions | Most common single-area adjustment |
| 98941 | Three to four spinal regions | Mid-back or multi-area treatment |
| 98942 | Five spinal regions | Full-spine corrective session |
| 98943 | Extraspinal regions (e.g., shoulder, hip) | Not covered by Original Medicare |
Code 98943 is the trap. Chiropractors bill extraspinal manipulation under it, yet Original Medicare never reimburses that line item. If a bill shows 98943 alongside an approved 98940, only the spinal code moves through Medicare, and the rest becomes your responsibility.
What Medicare Refuses to Pay and the Billing Language That Reveals It
The list of services Medicare excludes from a chiropractic visit is longer than the list it covers, and most patients only discover the gap when a bill arrives. Diagnostic X-rays, orthopedic evaluations, posture analysis, and most physical therapy modalities performed in the same office are contractually non-covered under CMS rules.
Maintenance adjustments get denied for the same reason CMS excludes them in the first place: they lack medical necessity. Once you have reached maximum therapeutic improvement and continued adjustments serve only to preserve that state rather than correct a subluxation, the service falls outside Medicare’s definition of active care.
How Denials Appear on Paper
The Medicare Summary Notice (MSN) labels every denied line item with a reason code. Two of the most common flags in chiropractic claims are worth memorizing.
| Reason Code | What It Means |
|---|---|
| CO-50 | Service is not covered under Medicare benefits |
| CO-97 | Service bundled into another payment already processed |
| CO-151 | Frequency or coverage limits exceeded |
Tip: Always request an itemized bill from the chiropractor’s office and compare each line to your MSN. Hot/cold packs, electrical stimulation, and ultrasound are commonly added without explicit consent and almost always become patient responsibility.
These line items are your responsibility even when the manipulation itself is covered, which is why a $40 visit can turn into a $150 surprise.
Out-of-Pocket Costs Beneficiaries Should Expect in 2024
The dollar mechanics of Medicare chiropractic coverage follow the standard Part B formula: meet the annual deductible, then pay your share of the approved amount. The 2024 numbers are concrete and worth knowing before your first appointment.
The annual Part B deductible is $240. Until that amount is met across all Part B services (not just chiropractic), Medicare pays nothing toward approved manipulation claims. After the deductible is satisfied, Medicare covers 80% of the approved amount for spinal manipulation, and you owe the remaining 20% coinsurance.
What the Approved Amount Looks Like
Medicare-approved amounts for chiropractic codes vary by state and by locality, but a typical single-region adjustment (CPT 98940) generates a national median reimbursement in the $30 to $55 range. Multi-region visits (98941 or 98942) run higher, and the geographic wage index can push or pull that figure by 20% or more depending on where you live.
For a beneficiary who has met the deductible, a $40 approved adjustment translates to roughly $8 out-of-pocket for the visit. The number climbs fast once the chiropractor adds uncovered modalities to the bill.
How Medigap Changes the Math
Supplement plans pick up the 20% coinsurance in different ways. Plan G covers it entirely after the deductible, which effectively eliminates out-of-pocket cost for approved chiropractic visits. Plan N requires a small copay per visit, usually up to $20, in addition to the 20% coinsurance on certain services. Choosing between the two depends on how often you expect to use Medicare-covered care, and how much premium difference you can absorb each month.
Original Medicare leaves those gaps wide open, which is why many beneficiaries weigh a switch to Medicare Advantage despite its quirks.
Why Medicare Advantage Often Looks More Generous, and Where It Falls Short
Medicare Advantage (Part C) plans frequently advertise richer chiropractic benefits than Original Medicare, and many do follow through. Fixed annual visit caps, reduced copays for spinal manipulation, and occasional coverage of extraspinal adjustments are common selling points.
The trade-off lives in the network. Chiropractors in-network with one Part C carrier may be out-of-network with another even within the same ZIP code, and prior authorization is often required before the plan agrees to pay. That administrative layer delays care, and the network narrowing can mean switching chiropractors mid-treatment if your plan changes its contract mid-year.
Original Medicare vs. Medicare Advantage Side by Side
| Feature | Original Medicare (Part B) | Medicare Advantage (Part C) |
|---|---|---|
| Spinal manipulation for subluxation | Covered | Covered |
| Extraspinal manipulation (98943) | Not covered | Sometimes covered |
| Annual visit cap | None (medical necessity rules apply) | Common, often 12–30 visits |
| Network restrictions | Any Medicare-enrolled chiropractor | Plan-specific network |
| Prior authorization | Not required | Often required |
| Out-of-pocket exposure | 20% coinsurance after deductible | Varies by plan; copay structure common |
The best Medicare Advantage plan for chiropractic care is rarely a national answer. Local network quality, the formulary-style rules the plan applies to ancillary services, and tolerance for utilization review matter more than the brochure benefit summary.
Finding a Chiropractor Who Actually Accepts Medicare Assignment
The words “accepts Medicare” hide three very different billing relationships. A participating chiropractor agrees to accept the Medicare-approved amount as full payment, which protects you from balance billing above the 20% coinsurance. A non-participating provider can charge up to 15% above the Medicare-approved rate, creating out-of-pocket exposure that catches patients unprepared. An opted-out chiropractor requires payment in full at the time of service, and Medicare returns nothing.
Even with the right provider, claims can still be denied, and the appeals process has its own ladder to climb.
Three Reliable Filters
- Use the Medicare.gov provider lookup. The Care Compare tool flags each provider’s participation status, and you can filter by ZIP code and specialty.
- Call your state chiropractic association. Most maintain directories of members who regularly bill Medicare, and the front-office staff can confirm participation directly.
- Ask the billing office one specific question. “Do you accept Medicare assignment on CPT codes 98940 through 98943?” If the answer is yes, you are protected from balance billing on covered services.
Heads up: A chiropractor can be enrolled in Medicare but still choose not to accept assignment. Enrollment means they can bill Medicare; accepting assignment means they accept what Medicare pays as full payment. The two are not the same.
Appealing a Denied Chiropractic Claim Through the Five CMS Levels
When Medicare denies a claim you consider valid, the appeals process follows a structured five-level path defined by federal regulation. Knowing each stage and the deadlines attached to them keeps your options open if a denial letter arrives.
The Five Levels in Order
- Redetermination, Handled by the Medicare Administrative Contractor (MAC) that processed the claim. Must be filed within 120 days of the denial notice.
- Reconsideration, Reviewed by a Qualified Independent Contractor (QIC). Deadline is 180 days after the redetermination decision.
- Administrative Law Judge hearing, Available for claims above the dollar threshold in dispute. Request within 60 days of the reconsideration decision.
- Departmental Appeals Board review, Reviews ALJ decisions for legal or procedural error. Filed within 60 days.
- Federal district court, Final judicial review for claims meeting the minimum amount-in-contest requirement.
Most successful chiropractic appeals resolve at the first or second level when documentation of vertebral subluxation is strong. Records that help include the chiropractor’s treatment notes showing acute symptoms, measurable functional improvement, and a clear plan for active corrective care.
What Strengthens an Appeal
Letters from a primary care physician documenting medical necessity carry meaningful weight at every stage. Imaging rationale, treatment frequency, and a written explanation of why the patient has not reached maximum therapeutic improvement all support the argument that the adjustment qualifies as active care rather than maintenance.
The Bottom Line
Medicare chiropractic coverage is real but narrow: manual manipulation of the spine to correct a subluxation, billed under one of three reimbursable CPT codes, after the Part B deductible is met, with 20% coinsurance left over. Everything else on the bill is your responsibility, and Medigap is the cleanest way to close the gap. Find a chiropractor who accepts Medicare assignment, verify the CPT codes on every statement, and appeal denials within 120 days if the documentation supports active care.
FAQ
Does Medicare cover chiropractic adjustments?
Yes, but only manual manipulation of the spine to correct a vertebral subluxation, billed under CPT 98940, 98941, or 98942. Extraspinal adjustments (98943), X-rays, exams, and maintenance therapy are not covered.
How many chiropractic visits does Medicare allow per year?
There is no annual cap on covered visits. Medicare pays for spinal manipulation as long as medical necessity is documented for each visit, meaning active corrective care for an acute or chronic subluxation.
What does Medicare pay for at a chiropractor?
After the annual Part B deductible, Medicare pays 80% of the approved amount for spinal manipulation under CPT 98940, 98941, or 98942. You owe the remaining 20% coinsurance, plus the full cost of any non-covered services billed alongside.
Does Medicare require a referral for chiropractic care?
No. Medicare does not require a physician referral for chiropractic services, though a physician’s letter of medical necessity can strengthen an appeal if a claim is denied.
Will Medicare cover chiropractic for maintenance care?
No. Maintenance adjustments, those given after maximum therapeutic improvement has been reached, are contractually excluded under CMS National Coverage Determination 150.1 and will be denied.
How much does a chiropractic visit cost with Medicare?
A typical single-region adjustment generates a Medicare-approved amount of $30 to $55. After the Part B deductible is met, your 20% coinsurance comes to roughly $6 to $11 per visit, and Medigap Plan G can eliminate that coinsurance entirely.
