What Does Medicare Cover for Chiropractic Services?
As of 2026, Medicare covers only one chiropractic service: manual manipulation of the spine to correct a subluxation, billed under CPT codes 98940 (one to two spinal regions), 98941 (three to four regions), or 98942 (five regions). Medicare does not cover chiropractic examinations, x-rays, diagnostic tests, massage therapy, electrical stimulation, ultrasound, manual therapy (CPT 97140), therapeutic exercises, or any other service performed by a chiropractor, regardless of medical necessity. This coverage limitation has been in place since Medicare first included chiropractic services in 1972 and has not been expanded despite repeated legislative efforts.
- What is covered: Manual spinal manipulation (98940, 98941, 98942) for subluxation documented by x-ray or physical examination. The AT modifier must be appended to indicate active treatment.
- What is excluded: Examinations, x-rays, diagnostic imaging, maintenance therapy, massage, electrical stimulation, ultrasound, manual therapy (97140), therapeutic exercises, and all other services. These are excluded by statute, not by medical necessity determination.
- The ABN requirement: When a chiropractor provides an excluded service to a Medicare beneficiary, an Advance Beneficiary Notice of Noncoverage (ABN) must be signed before the service so the patient can be billed directly.
Medicare Chiropractic Coverage Rule
Section 1861(r)(5) of the Social Security Act defines chiropractic services covered under Medicare as manual manipulation of the spine to correct a subluxation. That statutory language has not changed since 1972. It means Medicare covers only the hands-on adjustment of the spine, and nothing else a chiropractor does, regardless of licensure, scope of practice, or clinical appropriateness.
This is a statutory exclusion, not a coverage determination. Medicare Benefit Policy Manual Chapter 15, Section 240 reinforces that all services other than manual manipulation of the spine are excluded from Medicare coverage when performed by a chiropractor. The exclusion applies even when the same service would be covered if performed by a physician, physical therapist, or other Medicare-eligible provider. A chiropractor who performs an examination to determine whether spinal manipulation is indicated cannot bill Medicare for that examination. A chiropractor who orders an x-ray to document a subluxation cannot bill Medicare for the x-ray.
In our experience matching chiropractic providers with billing partners, the most expensive misunderstanding in chiropractic Medicare billing is the belief that because a state license permits a chiropractor to perform examinations, order imaging, or deliver physical therapy modalities, Medicare will pay for them. It will not. State scope of practice and Medicare coverage are two separate systems, and the Medicare limitation is statutory, not administrative. For how the Chiropractic Medicare Coverage Modernization Act proposes to change this, see our full overview.
What Can and Cannot Be Billed to Medicare
| Service | CPT Code(s) | Medicare Coverage | Billing Action |
|---|---|---|---|
| Spinal manipulation (1-2 regions) | 98940 | Covered with AT modifier | Bill Medicare |
| Spinal manipulation (3-4 regions) | 98941 | Covered with AT modifier | Bill Medicare |
| Spinal manipulation (5 regions) | 98942 | Covered with AT modifier | Bill Medicare |
| Chiropractic examination | 99202-99215 | Not covered | ABN required; bill patient |
| Diagnostic x-ray | 72020, 72040, etc. | Not covered | ABN required; bill patient |
| Manual therapy | 97140 | Not covered | ABN required; bill patient |
| Therapeutic exercise | 97110 | Not covered | ABN required; bill patient |
| Electrical stimulation | 97032, 97014 | Not covered | ABN required; bill patient |
| Massage therapy | 97124 | Not covered | ABN required; bill patient |
| Maintenance therapy | 98940-98942 without AT | Not covered (maintenance) | ABN required; bill patient |
The table above is the complete picture of what a chiropractor can and cannot bill to Medicare. Every service outside of 98940, 98941, and 98942 with the AT modifier is excluded. No modifier, no appeal, and no documentation overcomes a statutory exclusion. For the spinal manipulation codes specifically and how to document them for clean Medicare claims, see our CPT 98940 billing guide.
Medicare chiropractic billing is deceptively simple: three CPT codes, one modifier, and a statutory exclusion on everything else. But the ABN process, the maintenance therapy cutoff, and the subluxation documentation requirements trip up practices constantly. A billing partner with chiropractic-specific Medicare experience handles the compliance so you do not have to. Chiropractor Billers matches your practice with vetted billing companies, free.
How Does the AT Modifier Work for Chiropractic Medicare Claims?
The AT modifier (Active Treatment) must be appended to every chiropractic manipulation code (98940, 98941, 98942) billed to Medicare to indicate that the treatment is active, corrective care for a documented subluxation rather than maintenance therapy. Without the AT modifier, the claim is processed as maintenance therapy and denied.
Active treatment means the chiropractor expects measurable improvement in the patient’s condition. Once the patient reaches maximum therapeutic benefit (MTB) and the treatment shifts to maintaining the achieved level of function rather than improving it, the treatment becomes maintenance therapy and Medicare no longer covers it. The chiropractor must document measurable progress in the treatment plan to support continued use of the AT modifier.
One question we hear constantly from chiropractic practice managers is how to determine when a patient has reached MTB and the AT modifier should stop. The answer is clinical and must be documented: when the patient is no longer demonstrating measurable improvement in the condition being treated, the treatment is maintenance. Continuing to bill with the AT modifier after the patient has plateaued is a compliance risk that Medicare contractors actively audit. The billing team must track the transition and switch to an ABN-supported patient billing model when active treatment ends.
When Do You Need an ABN for Chiropractic Services?
An Advance Beneficiary Notice of Noncoverage (ABN) is required before a chiropractor provides any service to a Medicare beneficiary that Medicare does not cover. This includes every excluded service (exams, x-rays, manual therapy, therapeutic exercises) and any spinal manipulation that has transitioned from active treatment to maintenance therapy.
The ABN must be signed before the service is rendered, not after. A retroactive ABN is invalid, and without a valid ABN, the chiropractor cannot bill the patient for the excluded service. The practice absorbs the cost.
The ABN process for chiropractic practices works as follows:
- Identify the excluded service. Any service other than spinal manipulation with the AT modifier is excluded. Maintenance manipulation is also excluded.
- Present the ABN before the service. The ABN must specify the service, the reason Medicare may not pay, and the estimated cost to the patient. Use the CMS-approved ABN form (CMS-R-131).
- Let the patient choose. The patient selects Option 1 (receive the service and allow Medicare to be billed, accepting financial responsibility if denied), Option 2 (receive the service and pay out of pocket without a Medicare claim), or Option 3 (decline the service).
- Bill with the GA or GY modifier. GA indicates a signed ABN is on file. GY indicates the service is statutorily excluded. For excluded chiropractic services, GY is typically appropriate.
- Keep the signed ABN on file. Retain the signed ABN for at least five years. Medicare contractors audit ABN compliance, and a missing ABN means the practice cannot collect from the patient.
Common Chiropractic Medicare Errors
Across the billing companies we vet for chiropractic practices, five Medicare billing errors account for the majority of denials and compliance exposure.
- Billing excluded services to Medicare. Submitting an exam (99213), an x-ray (72020), or manual therapy (97140) to Medicare under a chiropractor’s NPI denies every time. These are statutory exclusions, and billing them wastes time and flags the practice for review.
- Missing the AT modifier on active treatment claims. A manipulation code submitted without the AT modifier is processed as maintenance therapy and denied. This is the most common chiropractic Medicare denial.
- Continuing the AT modifier after the patient reaches MTB. Billing active treatment after the patient has plateaued is a compliance risk. Medicare contractors run pattern audits on chiropractors who bill the AT modifier on every visit for extended periods.
- No ABN before excluded or maintenance services. Without a signed ABN, the practice cannot collect from the patient for excluded services. The practice absorbs the cost of every excluded service rendered without a valid ABN.
- Inadequate subluxation documentation. Medicare requires the subluxation to be documented by x-ray or by physical examination findings that include at least two of the following four criteria: asymmetry or misalignment, range of motion abnormality, tissue or tone changes, and palpatory tenderness. Missing this documentation makes the manipulation claim itself vulnerable to denial.
Frequently Asked Questions
Does Medicare cover chiropractic exams?
No. Medicare does not cover examinations performed by a chiropractor, including new patient exams (99202-99205) and established patient exams (99211-99215). This is a statutory exclusion. The chiropractor may perform the exam and bill the patient directly with a signed ABN.
Does Medicare cover chiropractic x-rays?
No. Medicare does not cover diagnostic x-rays ordered or performed by a chiropractor. The x-ray may be used to document a subluxation for the treatment record, but it cannot be billed to Medicare under a chiropractor’s NPI. A signed ABN is required to bill the patient.
What is the AT modifier in chiropractic billing?
The AT (Active Treatment) modifier is appended to CPT codes 98940, 98941, and 98942 to indicate that the spinal manipulation is active corrective care, not maintenance therapy. Without the AT modifier, Medicare denies the claim. The AT modifier should only be used when the patient is demonstrating measurable improvement.
What is maintenance therapy under Medicare?
Maintenance therapy is chiropractic treatment that maintains the patient’s current condition rather than producing measurable improvement. Medicare does not cover maintenance therapy. When a patient reaches maximum therapeutic benefit, the chiropractor must stop billing with the AT modifier and use an ABN to bill the patient directly.
Can a chiropractor bill Medicare for manual therapy (97140)?
No. CPT 97140 (manual therapy) is not covered by Medicare when performed by a chiropractor. The same service would be covered if performed by a physical therapist or physician, but the statutory limitation on chiropractic coverage restricts reimbursement to spinal manipulation only.
Will Medicare ever expand chiropractic coverage?
The Chiropractic Medicare Coverage Modernization Act has been introduced in multiple sessions of Congress but has not been enacted as of October 2026. If passed, the bill would expand Medicare coverage to include chiropractic examinations, diagnostic imaging, and other services within the chiropractor’s state scope of practice. The current statutory limitation remains in effect.
Next Steps
- For spinal manipulation coding and documentation requirements, see our CPT 98940 billing guide.
- For the legislative effort to expand Medicare chiropractic coverage, see our Chiropractic Medicare Coverage Modernization Act overview.
- Ready to stop losing revenue on Medicare billing errors? Get matched with a chiropractic billing partner who knows the rules.
Medicare chiropractic billing is three codes, one modifier, and a wall of excluded services that require ABNs to bill the patient. Getting any of it wrong costs your practice money on every Medicare visit. Chiropractor Billers matches your practice with vetted billing companies that specialize in chiropractic Medicare compliance. Free quotes, all 50 states, rates starting at 2.95%.
