Will Medicare Pay For Xrays Ordered By A Chiropractor (2025)

Medicare does not cover services or tests ordered by chiropractors, including X-rays, massage therapy, and acupuncture. Beneficiaries are responsible for out-of-pocket payments for these procedures. While Medicare covers physician-ordered X-rays necessary for validating spinal subluxation treatment, it excludes X-rays ordered or performed by chiropractors. Additionally, services beyond manual spinal manipulation are not covered. Therefore, if a chiropractor recommends an X-ray, patients will have to pay for it themselves.

Original Medicare (Parts A and B) does not provide coverage for any type of diagnostic test ordered by a chiropractor. This includes massage therapy and acupuncture unless specifically covered for other medical reasons. Medicare Advantage plans (Part C) may have different coverage rules, but generally align with Original Medicare’s restrictions on chiropractor-ordered diagnostics.

Medicare is strict about compensating only for manual manipulation aimed at correcting vertebral subluxation and does not extend coverage to services directed at extraspinal regions, like the head, limbs, or abdomen. Any tests that chiropractors order for further demonstration of medical necessity, including X-rays, are not eligible for Medicare coverage if initiated by a chiropractor.

Patients needing these additional services or tests should consult their primary care physician for possible alternatives. Ultimately, coverage is limited to specific chiropractic services directly related to spinal treatment, with all other orders and tests falling to the patient to cover financially. In summary, while chiropractic care for certain spinal conditions is included, ancillary services, tests, and treatments ordered by chiropractors are excluded from Medicare coverage.

What Are The Two Types Of Chiropractors?

There are two main types of chiropractors: musculoskeletal chiropractors, who focus on symptom relief, and traditional or subluxation-based chiropractors, who focus on structural correction. Understanding these distinctions can guide individuals in choosing the appropriate type for their needs. Traditional chiropractors prioritize diagnosis and holistic care aimed at correcting vertebral subluxations, while musculoskeletal chiropractors address acute or chronic back pain through non-invasive methods. Additionally, there are various chiropractic specialties, including naturopathic, occupational, and prenatal chiropractic care.

The primary objectives of chiropractic care revolve around alleviating pain and improving overall structure and function. While both types share an ultimate goal of enhancing patient health, their methods and philosophies vary significantly. Patients experiencing musculoskeletal issues like back pain will benefit from seeing a practitioner specializing in symptom relief, whereas those interested in wellness and structural alignment might prefer a traditional chiropractor.

Overall, awareness of these two primary categories and their unique treatment approaches—limited scope versus structural focus—will help individuals select the chiropractor best suited to their health and wellness objectives.

How Many Visits Does Medicare Allow For Chiropractic?

Medicare does not impose a limit on the number of chiropractic visits covered in a year, as long as each visit is deemed medically necessary for treating an altered vertebrae position. Coverage is primarily limited to manual manipulation of the spine aimed at correcting subluxation. While there are no specific annual limits for these treatments, Medicare generally only pays for the adjustments themselves and excludes other services that chiropractors may provide, such as X-rays, massage therapy, and acupuncture.

For chiropractic care to be covered by Medicare, the manipulation must be prescribed by a doctor and must meet criteria for medical necessity. Although there is no set limit on visits, beneficiaries are responsible for a 20% coinsurance fee after meeting their annual deductible.

Overall, Medicare allows for chiropractic visits to continue as long as they are clinically indicated, with coverage extending as long as each visit maintains the standards of medical necessity. Therefore, you may receive numerous chiropractic adjustments without a strict cap, provided all related services are justified under Medicare’s guidelines.

How Many Visits Does Medicare Cover For Chiropractic?

Original Medicare may not impose a strict limit on the number of chiropractic sessions covered for spinal manipulation, but it emphasizes the necessity of medical justification for each visit. While Medicare Part A does not cover chiropractor visits or corrective treatments for subluxations, patients must cover these expenses fully. Coverage extends only to medically necessary chiropractic services, with related diagnostic services such as X-rays, massage therapy, and acupuncture being excluded. Generally, treatments for basic back pain, particularly strain-related muscle pain, are not covered.

Under Medicare Part B, beneficiaries may receive coverage for manual spine manipulation, provided that sessions are deemed medically necessary. Typically, Medicare covers up to 12 chiropractic visits per year for spine manipulation, meeting specific medical criteria, with an additional eight visits allowed if symptoms show improvement. Coverage requires meeting the Medicare Part B deductible and entails a 20% coinsurance for each visit.

Ultimately, while there is no absolute limit to the number of chiropractic adjustments that Medicare covers, eligibility hinges on demonstrating medical necessity for the treatment. Patients benefit from up to 12 covered chiropractic sessions annually if these services are recommended by their physician and align with Medicare's guidelines. For those struggling with back pain or neck issues, understanding the coverage options and associated costs for Medicare chiropractic treatment is essential.

What Are The Two Basic Types Of Chiropractic Visits That Medicare Recognizes?

Medicare recognizes two types of chiropractic visits: Active care and maintenance care. Active care occurs when a chiropractor expects functional improvement in response to a significant health issue presented by the patient. Maintenance care follows to maintain health after active treatment. Medicare only covers specific services deemed medically necessary; it does not cover additional services like X-rays, massage therapy, or acupuncture. Under Medicare Part B, coverage includes manual manipulation of the spine to correct subluxation, which refers to spinal misalignment. Medicare does not cover chiropractic services under Part A.

For Medicare chiropractic claims, an AT modifier must be included to indicate active or corrective treatment for acute or chronic subluxation. Documentation should specify affected vertebrae and the degree and pain associated with the condition. The provided services under Medicare are limited to correcting spinal misalignments and include the initial examination and diagnosis. Chiropractic procedures covered are identified using specific coding: 98940 for one to two spinal regions, 98941 for three to four regions, and 98942 for five regions or more.

Notably, while certain chiropractic treatments are covered, the overall Medicare coverage for chiropractic services is unique compared to other medical services, focusing primarily on necessary spinal manipulations.

Does Medicare Cover X-Rays?

Medicare Part B provides coverage for medically necessary diagnostic X-rays ordered by healthcare providers, including tests such as CT scans, MRIs, EKGs, and PET scans. Coverage is dependent on where the X-ray is performed and the patient's Medicare status, ensuring that patients needing an X-ray due to pain or illness don't have to fear excessive costs. In most outpatient centers or as an outpatient hospital service, Medicare Part B generally covers these services. Typically, Original Medicare Part B pays 80% of the approved costs for X-rays, with beneficiaries responsible for the remaining 20% after meeting deductibles.

Patients needing X-rays must consider their out-of-pocket costs, which vary based on personal Medicare plans. While Medicare does not cover eyeglasses or contact lenses, it does cover all medically necessary diagnostic X-rays. It's crucial for beneficiaries to check their specific coverage details at Medicare. gov to understand their financial responsibility for diagnostic services. Each test or service's coverage may vary depending on location and other factors.

Additionally, Medicare Advantage plans may provide further coverage options for chiropractic services, but X-rays ordered by chiropractors are typically not covered. Overall, Medicare Part B ensures coverage for essential diagnostic X-rays while outlining potential costs associated with these critical healthcare services.

What Diagnosis Codes Does Medicare Cover For Chiropractic?

Doctors of chiropractic can only bill three Current Procedural Terminology (CPT) codes under Medicare: 98940 (one to two spinal regions), 98941 (three to four regions), and 98942 (five regions). An AT modifier must be added when performing active/corrective treatment for subluxation. For codes 98941 and 98942, chiropractors should input the two most significant primary diagnoses in Item 21 on the CMS1500 claim form or its electronic equivalent. Medicare only covers services that are medically necessary, consistent with statute requirements.

If a chiropractor orders or interprets an x-ray or other diagnostic tests, those are also covered if medically necessary. Specifically, Medicare covers codes 98940, 98941, and 98942 for chiropractic services; other codes will be denied or rejected. Claims should be submitted with an accompanying diagnostic code and the AT modifier for 98940, 98941, or 98942 to ensure coverage. Primary subluxation diagnosis codes must be supplemented by secondary diagnosis codes, with all accepted codes being defined in Local Coverage Determinations (LCDs) for various regions.

Chiropractors must ensure to use the appropriate ICD-10-CM codes to substantiate the medical necessity of the service being billed. The X series of codes is not applicable for chiropractors. It is crucial to have a thorough understanding of accepted codes and modifiers to avoid claim denials and ensure compliance with Medicare regulations.

How Many Times Can You Get Adjusted By A Chiropractor?

When starting a new chiropractic treatment plan, it is common to have multiple adjustments each week, often 2-3 times, especially for new patients or those with significant pain. As healing progresses, this frequency may decrease to once a week. For those who are pain-free and seeking to maintain their wellness, adjustments may be needed only once or twice a month.

The frequency of adjustments depends on the severity and type of condition. Acute pain or injury often necessitates several visits per week during the initial treatment phase. Chronic conditions like sciatica or arthritis may require ongoing care, typically 1-2 times per week once stability is reached.

The treatment plan can vary based on individual needs and lifestyle goals. For corrective care, most practitioners recommend a series of 6-12 visits over 4-6 weeks to address the underlying issues. Maintenance treatments generally occur every 2-4 weeks. Weekly visits can help some clients, while others may only need periodic adjustments.

It is important to note that while some chiropractors may suggest back-to-back visits for specific needs, research indicates that more than 2-3 adjustments per week usually do not provide additional benefits. Proper evaluation and re-assessment of progress help determine the right frequency for ongoing care.

Overall, the number of chiropractic adjustments should be tailored to the individual patient, considering factors such as the acute nature of the condition, chronic issues, and personal health goals. Regular check-ups can facilitate early intervention for any emerging issues.

What Do Medical Doctors Think Of Chiropractors?

Doctors generally enjoy collaborating with chiropractors and appreciate their care, especially in managing musculoskeletal disorders. A survey indicated that 52% of doctors had considerable knowledge of chiropractic, with 58% finding it useful and 43% expressing favorable views. Despite this, opinions vary significantly among orthopedic surgeons: 29% held positive views, 26% remained neutral, and 45% viewed chiropractors negatively.

Chiropractors, while not medical doctors, are licensed healthcare professionals focused on the diagnosis, treatment, and prevention of neuromuscular disorders using manual therapies and lifestyle advice.

The chiropractic profession dates back to the late 19th century and has grown to be the third largest group of primary healthcare providers in the U. S., following physicians and dentists. While many doctors regard chiropractic care as effective for certain musculoskeletal issues, skepticism remains regarding their lack of medical training, ability to prescribe medication, or order advanced diagnostic imaging. Historically, the medical community, including doctors and physical therapists, hesitated to refer patients to chiropractors, often due to a lack of understanding about the benefits of chiropractic care.

Although research into chiropractic's efficacy continues, evidence supports its use as a complementary treatment, suggesting that while opinions are mixed, chiropractors may play a valuable role in patient care for specific health issues.