What is the Chiropractic Medicare Coverage Modernization Act?
The Chiropractic Medicare Coverage Modernization Act, H.R. 539 and its Senate companion S. 106, is a pending bipartisan bill that would expand Medicare coverage of chiropractic services beyond manual spinal manipulation to include what a doctor of chiropractic is licensed to provide in their state. As of August 2026 it has 167 House cosponsors but has not passed, so nothing about current Medicare billing has changed yet.
- What it would add. Beyond the CMT codes 98940 to 98942, Medicare could cover E/M visits, therapy codes, and certain diagnostic and X-ray services a chiropractor is licensed to perform.
- Where it stands. It is pending in the 119th Congress with 167 House and 15 Senate cosponsors and still needs a committee vote. It is not law.
- What to do now. Billing does not change today, but practices can prepare documentation and coding workflows for a broader Medicare scope.
What the Bill Would Change
According to congress.gov, H.R. 539, the Chiropractic Medicare Coverage Modernization Act of 2025, was introduced by Representative Gregory Steube and would amend Title XVIII of the Social Security Act to provide Medicare coverage for all physicians’ services furnished by doctors of chiropractic within the scope of their license. The Congressional Research Service summary is blunt about the effect: it would expand Medicare coverage of chiropractic services to include all services provided by chiropractors, rather than only subluxation corrections through manual manipulation of the spine.
Today, Medicare covers a narrow slice of chiropractic care. Only the chiropractic CPT codes for spinal manipulation, 98940 through 98942, are payable, and only with the AT modifier for active treatment. Extraspinal manipulation (98943) is statutorily non-covered, and exams, X-rays, and therapy modalities performed by a chiropractor are not covered when the DC bills them. H.R. 539 would open Medicare to those additional services where a chiropractor’s state license already allows them.
The American Chiropractic Association, which has made this its top legislative priority, is careful to frame the bill as adding no new services. It would not change any state’s scope of practice; it would only let Medicare pay for services chiropractors are already licensed to deliver. The ACA has said that, at a minimum, the covered set would include E/M codes, therapy codes including but not limited to CMT, and certain diagnostic and X-ray codes, with doctors required to complete a one-time documentation training as determined by CMS.
Does H.R. 539 change chiropractic billing right now?
No. As of August 2026, H.R. 539 is a pending bill, not a law, so nothing about how you bill Medicare has changed. Spinal manipulation under 98940 to 98942 with the AT modifier remains the only covered chiropractic benefit, and exams, imaging, and modalities billed by a DC are still non-covered.
One question we hear constantly from practice managers is whether they can start billing Medicare for exams or X-rays now because the bill is gaining support. The answer today is no, and doing so invites denials and compliance exposure. Non-covered services billed to Medicare still require the GY modifier so the claim routes correctly to the patient or a secondary payer. Until a bill is signed into law and CMS issues implementing rules with an effective date, the current coverage rules stand. Watching the legislation is smart; billing as if it already passed is not.
Why This Is Gaining Momentum
The statute governing Medicare chiropractic coverage has not been meaningfully updated since chiropractic was first included in 1972, when manual manipulation was essentially the whole of the recognized benefit. Supporters argue that gap no longer reflects how chiropractors practice or how other federal programs already treat them.
Two forces are driving the current push. First, the opioid crisis has elevated non-drug, first-line approaches to musculoskeletal pain, and chiropractic care is frequently cited in that context. Second, supporters point to parity: the VA, the Department of Defense, federal employee health plans, and most private insurers already reimburse chiropractors for a broader range of licensed services than traditional Medicare does. In 2026 the advocacy also consolidated. The ACA and the International Chiropractors Association signed a memorandum of understanding to back a single bill, and a MAHA Chiropractic Hub launched to coordinate the profession. Chiropractors held a Washington fly-in from July 19 to 21, 2026, and state associations urged members to contact Congress before a late-July deadline, all aimed at securing the committee vote the bill still needs.
What would expanded coverage mean for your billing?
If H.R. 539 became law, the practical change for a chiropractic practice would be a wider set of Medicare-billable services, which means new code families, new documentation demands, and new denial risks layered onto a benefit that is already among the most audited in Medicare. It would be an opportunity and an operational lift at the same time. Here is the shift in plain terms:
| Chiropractic service | Medicare today (2026) | If H.R. 539 became law |
|---|---|---|
| Spinal manipulation, 98940 to 98942 | Covered with the AT modifier | Still covered |
| Extraspinal manipulation, 98943 | Statutorily non-covered | Potentially covered within license scope |
| Evaluation and management visits | Non-covered when billed by a DC | Potentially covered |
| X-rays and diagnostic imaging | Non-covered when billed by a DC | Potentially covered within license scope |
| Therapy services and modalities | Non-covered when billed by a DC | Potentially covered within license scope |
Source: congress.gov bill text and Congressional Research Service summary for H.R. 539 / S. 106, and American Chiropractic Association guidance. The right-hand column describes what the bill proposes; it is not current Medicare policy and applies only if the bill is enacted and implemented by CMS.
Across the billing companies we vet, the ones best positioned for a change like this are already fluent in E/M and diagnostic coding on the commercial and personal-injury side, where chiropractors bill those services today. The practices that would struggle are the ones that have only ever billed 98940 to 98942 to Medicare and would suddenly face E/M leveling, imaging medical necessity, and therapy documentation on federal claims for the first time.
How should chiropractic practices prepare for H.R. 539?
You cannot bill the expanded services yet, but you can be ready if the bill advances. Practical preparation now:
- Track the bill’s status at the congressional level rather than relying on advocacy emails, so you know when a committee vote or enactment actually happens.
- Tighten subluxation and medical-necessity documentation now, since broader coverage would bring more, not less, audit scrutiny.
- Keep billing current Medicare rules exactly as they stand, using the AT modifier for active care and GY for non-covered services.
- Map the E/M, therapy, and imaging codes you already bill commercially, because those are the workflows a Medicare expansion would activate.
- Plan for the documentation training the bill would require, so your providers are not scrambling after an effective date.
- Confirm your billing partner or team can handle E/M leveling and imaging medical necessity, not just CMT coding.
In our experience matching providers with billing partners, a coverage change of this size is where practices either capture the new revenue cleanly or drown in denials in the first quarter. The difference is almost always whether the billing operation was built for more than manual manipulation before the rules changed.
Want a billing partner ready for a broader Medicare chiropractic benefit, not just CMT codes? Get matched with billing companies that already handle E/M, imaging, and therapy coding for chiropractic practices. Free, with no obligation.
Common Misreadings of the Bill
A bill this consequential attracts confident misreadings, and each one carries real billing risk.
The first is treating it as already in effect. It is pending, and there is no Medicare effective date to bill against. The second is assuming it changes what chiropractors are allowed to do clinically; it does not touch state scope of practice, it only changes what Medicare will pay for within that existing scope. The third is starting to submit exams or X-rays to Medicare in anticipation, which still draws denials and can look like improper billing. The fourth is assuming passage is certain. National physician organizations, including the American Medical Association, have opposed the bill over scope and Medicare resource concerns, so the outcome is genuinely uncertain and should be tracked, not presumed.
Where Expert Billing Fits
Providers often come to us after a Medicare denial for a service that simply is not covered for a chiropractor today, which is exactly the confusion a coverage expansion would multiply if a practice is not prepared. Whether H.R. 539 passes this session or not, the direction of travel, more services, more documentation, more payer scrutiny, rewards a billing operation built for complexity.
That is what Chiropractor Billers is built to solve. Every request is reviewed by a real person on the Billing Service Quotes team and matched to billing companies with genuine chiropractic experience, weighed against your practice size, location, and EHR system, so you are not guessing whether a partner can handle E/M and imaging alongside CMT. You can read more about how the hand-reviewed matching process works before a scope change makes the right billing partner harder to find.
Frequently Asked Questions
Has H.R. 539 passed?
No. As of August 2026, the Chiropractic Medicare Coverage Modernization Act is pending in the 119th Congress with 167 House cosponsors and 15 in the Senate. It still needs a committee vote and has not been enacted, so current Medicare chiropractic billing rules remain in effect.
What would H.R. 539 let Medicare cover?
The bill would let Medicare pay for services a doctor of chiropractic is licensed to provide in their state, not just spinal manipulation. The ACA says that would include, at minimum, E/M codes, therapy codes, and certain diagnostic and X-ray codes, with a required documentation training.
Does Medicare cover chiropractic X-rays now?
No. As of 2026, Medicare does not cover X-rays or exams billed by a chiropractor. Only manual spinal manipulation under CPT 98940 to 98942 with the AT modifier is covered. Non-covered services should carry the GY modifier so the claim routes to the patient or secondary payer.
Would the bill change my state scope of practice?
No. H.R. 539 does not expand or alter any state’s chiropractic scope of practice. It only changes what Medicare will reimburse within the scope a chiropractor already holds under state license, bringing Medicare closer to how the VA, DoD, and private plans already pay.
When would the changes take effect?
There is no effective date because the bill has not passed. If it were enacted, CMS would still need to issue implementing rules, including the documentation training requirement, before expanded billing began. Until then, bill Medicare under current chiropractic coverage rules only.
Who supports and opposes the bill?
The bill is bipartisan, backed by the ACA, the ICA, and a broad group of House and Senate cosponsors. National physician organizations, including the American Medical Association, have opposed it over scope-of-practice and Medicare resource concerns, so its passage is not assured.
How should I prepare my billing now?
Keep billing current Medicare rules exactly, tighten documentation, and make sure your billing team or partner can handle E/M leveling, imaging medical necessity, and therapy coding. Those are the workflows a Medicare expansion would activate, and readiness prevents first-quarter denials.
Next Steps
- Confused about what Medicare covers today? Review the current chiropractic CPT codes and modifier rules.
- See how our hand-reviewed matching process works before you evaluate a new billing partner.
- Want a billing partner ready for a broader benefit? Get matched with a chiropractic billing company in as little as 30 minutes.
Whether or not H.R. 539 passes, chiropractic billing is only getting more complex. Get matched with chiropractic billing companies that handle CMT, E/M, imaging, and therapy coding with equal fluency, in as little as 30 minutes. Free, with no obligation.
