Understanding Medicare and Chiropractic Care: A Guide for Patients

What Does Medicare Cover?

Medicare Part B offers coverage for chiropractic care, but it's limited to manual manipulation of the spine to correct a vertebral subluxation. This condition involves spinal joints that fail to move properly, maintaining contact between the joints. It's crucial to note that Medicare does not cover examinations or other chiropractic services including soft tissue release, laser therapy or shockwave.

Your Financial Responsibilities

Under Medicare Part B, after you meet your deductible, you're responsible for 20% of the Medicare-approved amount for covered services. The total cost may vary depending on additional insurance, the doctor’s charges, and whether the doctor accepts assignment. For services provided by GoChiroMobile, you are required to pay for the services upfront. Medicare may reimburse you for the spinal adjustments, which is approximately $40 minus any copay or deductible 

Services Not Covered by Medicare

As a non-par provider, it's essential for our patients to understand that Medicare will only cover the cost of spinal adjustments (CPT codes 98940, 98941, 98942). This means that examinations, therapies, the house call fee ($20 within our service area), and any other procedures provided by us will not be reimbursed by Medicare. Patients must cover these costs themselves

Maintenance Therapy and Medicare

It's important to note that Medicare does not cover maintenance therapy. Once clinical improvement is not expected from ongoing care, and the treatment shifts from corrective to supportive in nature, it falls into the category of
maintenance therapy. This includes services aimed at preventing disease, promoting health, and maintaining or preventing deterioration of a chronic condition. Medicare will not cover such services when they become supportive rather than corrective

Medicare Advantage Plans

For those with Medicare Advantage plans, the coverage details for chiropractic services can differ from traditional Medicare. It's important to verify your specific benefits with your plan provider to understand your coverage fully 

At GoChiroMobile, we are committed to providing exceptional chiropractic care that aligns with your health and wellness goals. We're here to support you every step of the way, from understanding your Medicare benefits to delivering personalized care at your convenience.