Does Medicare Cover Chiropractic? The Complete Provider & Patient Guide

The short answer is yes — Medicare does cover chiropractic care. But the coverage is far more limited than most patients expect, and the documentation requirements are far more demanding than most providers realize. Getting this wrong leads to denied claims, audits, and repayment demands that can devastate a small practice.

This guide covers exactly what Medicare pays for, what it excludes, what documentation you need, and how to stay compliant as an independent chiropractor billing Medicare in 2026.

What Medicare Covers

Medicare Part B covers one specific chiropractic service: manual manipulation of the spine to correct a subluxation. That's it. The subluxation must be demonstrated either by X-ray or through specific physical examination findings documented in the patient's chart.

The covered CPT codes are:

• 98940 — Chiropractic manipulative treatment (CMT), spinal, 1-2 regions
• 98941 — CMT, spinal, 3-4 regions
• 98942 — CMT, spinal, 5 regions

These codes must be billed with the AT modifier to indicate that the treatment is active/corrective rather than maintenance. Without the AT modifier, Medicare will deny the claim.

What Medicare Does NOT Cover

This is where most confusion — and most billing errors — occur. Medicare explicitly excludes:

• X-rays ordered by the chiropractor — Even though X-rays can be used to demonstrate subluxation, Medicare does not pay chiropractors for the X-ray itself. If you need an X-ray for documentation, the patient must get it from another provider, or you must inform the patient it's not covered.
• Maintenance therapy — Once the patient has reached maximum therapeutic benefit (MTB), continued treatment is considered maintenance and is not covered. This is the #1 audit trigger for chiropractic practices.
• Extraspinal manipulation — Manipulation of extremities (shoulders, knees, etc.) is not a covered Medicare benefit for chiropractors.
• Evaluation and Management (E/M) services — Medicare does not cover office visits, exams, or consultations billed by chiropractors.
• Adjunctive therapies — Ultrasound, electrical stimulation, heat/cold packs, therapeutic exercise, and all other modalities are excluded.

The AT Modifier Requirement

Every Medicare chiropractic claim must include the AT modifier (Active Treatment) appended to the CMT code. This modifier tells Medicare that the manipulation is part of an active treatment plan to correct a subluxation — not maintenance care to prevent future problems.

Using the AT modifier creates an affirmative representation to CMS that:

• The patient has a documented subluxation
• A treatment plan exists with specific goals and timeframes
• The patient has not yet reached maximum therapeutic benefit
• Measurable improvement is being documented at each visit

If an audit reveals that you billed with the AT modifier for visits where the patient had already reached MTB, you face repayment demands plus potential false claims liability. This is the single highest-risk compliance issue in chiropractic Medicare billing.

Subluxation Documentation Requirements

Medicare requires subluxation to be demonstrated before treatment begins. There are two acceptable methods:

Method 1: X-Ray Evidence

An X-ray showing subluxation must have been taken no more than 12 months prior to the start of treatment. The X-ray report must specifically identify the subluxation — a general "degenerative changes" reading is insufficient.

Method 2: Physical Examination

If you use physical examination instead of X-ray, you must document at least two of the following four criteria:

• Pain/tenderness — documented with specific location, quality, and severity
• Asymmetry/misalignment — specific spinal level and direction
• Range of motion abnormality — measured and documented with specific degrees
• Tissue/tone changes — specific findings (spasm, edema, etc.) at identified levels

The findings must be documented in the initial evaluation note and referenced in the treatment plan. Vague notes like "subluxation noted" without supporting findings will not survive an audit.

Active Treatment vs. Maintenance Care

The distinction between active treatment and maintenance care is the most consequential compliance decision you make on every single visit. Active treatment is covered; maintenance is not.

Active treatment means the patient is making measurable functional improvement toward documented goals. Each visit note should document what improved, by how much, and how that relates to the treatment plan goals.

Maintenance care begins when the patient reaches maximum therapeutic benefit — when further improvement is not expected. This does not mean the patient doesn't benefit from continued care; it means Medicare won't pay for it.

When a patient transitions from active to maintenance care, you must:

1. Stop billing Medicare (remove the AT modifier)
2. Have the patient sign an ABN before the next visit
3. Bill the patient directly for continued maintenance care

How Much Does Medicare Pay?

Medicare reimburses chiropractic manipulation at rates determined by the Medicare Physician Fee Schedule, which varies by geographic locality. As of 2026, typical allowed amounts are approximately:

• 98940 (1-2 regions): $28–$35
• 98941 (3-4 regions): $48–$58
• 98942 (5 regions): $62–$75

Medicare pays 80% of the allowed amount after the patient meets their Part B deductible. The patient is responsible for the remaining 20% coinsurance. If the patient has a Medigap (supplemental) policy, it typically covers the 20% coinsurance.

Visit Limits

Medicare does not impose a specific visit limit on chiropractic care. However, this does not mean unlimited visits are covered. Every visit must be medically necessary, part of an active treatment plan, and documented with measurable improvement. In practice, most Medicare Administrative Contractors (MACs) will scrutinize treatment plans that extend beyond 12 visits without re-evaluation and updated goals.

Common Audit Triggers

The OIG and Medicare MACs actively audit chiropractic billing. The most common triggers include:

• High volume of 98941/98942 codes relative to 98940 — billing the higher-paying codes on nearly every visit raises flags
• Long treatment durations — patients receiving CMT weekly for 6+ months without re-evaluation
• Identical visit notes — copy-paste notes that show no individualized assessment or improvement tracking
• Missing AT modifier documentation — billing AT without chart notes supporting active treatment status
• No ABN on file for non-covered services rendered

Medicare Advantage Plans

Medicare Advantage (Part C) plans may offer expanded chiropractic benefits beyond what original Medicare covers. Some MA plans cover additional visits, X-rays, or even adjunctive therapies. However, each plan sets its own rules, prior authorization requirements, and reimbursement rates.

If you see Medicare Advantage patients, you must verify the specific plan's chiropractic coverage before rendering services. Do not assume that MA plans follow the same rules as original Medicare.

Bottom Line for Providers

Medicare chiropractic coverage is narrowly defined but consistent. The rules haven't changed substantially in years. What has changed is enforcement — OIG audit activity on chiropractic billing has increased significantly since 2023, and the most common finding is billing for maintenance care with the AT modifier.

The practices that avoid audit problems are the ones that document meticulously, transition patients to ABN-covered maintenance care when improvement plateaus, and treat the AT modifier as a compliance commitment rather than a billing checkbox.