Here's the short version. Medicare covers both, but only in narrow cases. Chiropractic: Part B covers manual manipulation of the spine by a chiropractor to correct a vertebral subluxation. It does not cover other services or tests a chiropractor orders, including X-rays, massage therapy, and acupuncture. Acupuncture: Part B covers acupuncture only for chronic low back pain, up to 12 treatments in 90 days, with up to 8 more if you improve. For both, after you meet the Part B deductible, you pay 20% of the Medicare-approved amount. The rest of this page explains the limits and how to avoid surprise bills.
Does Medicare cover chiropractic care?
Yes, for one specific service. Part B covers manual manipulation of the spine by a chiropractor to correct a vertebral subluxation. That is when the spinal joints fail to move properly, but the contact between the joints stays intact. In everyday words: Medicare pays for the spinal adjustment itself, when it is treating a problem with how your spine moves.
Medicare does not cover other services or tests a chiropractor orders. That includes X-rays, massage therapy, and acupuncture. So if a chiropractor's office bundles an exam, X-rays, massage, or supplements with your adjustment, Medicare pays only for the adjustment. You pay the rest in full.
Does Medicare cover acupuncture?
Only for chronic low back pain. Part B covers acupuncture, including dry needling, when your low back pain meets all of these:
- It has lasted 12 weeks or longer.
- It has no known cause. For example, it is not related to cancer that has spread, or to an inflammation or infectious disease.
- It is not tied to surgery or pregnancy.
Acupuncture for anything else, such as neck pain, headaches, or knee pain, is not covered by Original Medicare. You would pay the full cost.
How many acupuncture visits Medicare covers
Medicare covers up to 12 acupuncture treatments in 90 days for chronic low back pain. If you show improvement, Medicare covers an additional 8 sessions, for a maximum of 20 treatments in a 12-month period. If you are not improving, Medicare will not cover more treatments, and you pay 100% of the cost if you keep going.
Who can give covered acupuncture
This rule trips people up. Medicare cannot pay licensed acupuncturists directly for their services. You must get acupuncture from a doctor or another health care provider, like a nurse practitioner or physician assistant. That provider must have both a master's or doctoral degree in acupuncture or Oriental medicine from an accredited school, and a current, full, active, unrestricted license to practice acupuncture in the state where you get care. Before your first visit, ask whether the provider bills Medicare for acupuncture. If not, Medicare will not pay.
What you pay
For covered chiropractic care and covered acupuncture, the cost rule is the same. After you meet the Part B deductible, you pay 20% of the Medicare-approved amount. What you actually owe also depends on other insurance you have, how much your provider charges, whether your provider accepts assignment, the type of facility, and where you get the service. Ask the office how much it will cost before you start.
Medicare also warns that your doctor may recommend services Medicare does not cover, or offer them too often, which can leave you with extra costs. Ask about the reasons for each recommendation and what Medicare will actually cover. Our costs guide explains deductibles and coinsurance.
Coverage at a glance
| Service | Original Medicare (Part B) |
|---|---|
| Spinal adjustment by a chiropractor for subluxation | Covered. 20% after the deductible. |
| X-rays ordered by a chiropractor | Not covered. |
| Massage therapy | Not covered. |
| Acupuncture for chronic low back pain (12 weeks or longer) | Covered, up to 12 treatments in 90 days, plus 8 more if you improve. 20% after the deductible. |
| Acupuncture for other conditions | Not covered. |
| Acupuncture billed directly by a licensed acupuncturist | Not covered. Must be through a qualified doctor or other provider. |
Medicare Advantage and Medigap
A Medicare Advantage plan must cover at least what Original Medicare covers. Some plans add extra chiropractic or acupuncture benefits beyond that, with their own copays, visit limits, and network rules. Read the plan's Evidence of Coverage or call the plan to confirm before you book. If you have Original Medicare with a Medigap policy, the policy may pay some or all of your 20% share for covered services. It does not add coverage for services Medicare excludes, like massage.
Common questions
Does Medicare pay for X-rays at the chiropractor?
No. Medicare does not cover X-rays or other tests a chiropractor orders. An X-ray ordered by your medical doctor is a different matter and may be covered under Part B's normal imaging rules.
Does Medicare cover massage therapy?
No. Massage therapy is listed among the services Medicare does not cover, even when a chiropractor provides it. Some Medicare Advantage plans offer it as an extra benefit. Check with the plan.
Can I go to my regular acupuncturist and have Medicare pay?
Only if that person meets Medicare's rules. Medicare cannot pay licensed acupuncturists directly. The acupuncture must come from a doctor or another provider, such as a nurse practitioner or physician assistant, who holds the required acupuncture degree and license. Ask before your first visit.
How many acupuncture sessions will Medicare cover in a year?
Up to 12 treatments in 90 days for chronic low back pain, and 8 more if you improve. That is a maximum of 20 treatments in a 12-month period. If you are not improving, Medicare stops covering treatments and you pay the full cost.
Do I need a referral for chiropractic care under Medicare?
Original Medicare's coverage rule is about the service, not a referral: manual manipulation of the spine to correct a subluxation. Medicare Advantage plans set their own rules and may require a referral or prior approval. Check with your plan.
Related pages
- Medicare Part B — what medical insurance covers and how assignment works.
- Coverage Basics — how Original Medicare, Medicare Advantage, and Medigap fit together.
- Does Medicare Cover Dental, Vision, and Hearing? — other routine care Original Medicare leaves out.
- Does Medicare Cover Therapy and Mental Health Care? — counseling and psychiatric care under Part B.
- Understanding Your Costs — deductibles, coinsurance, and how bills add up.
Official sources: Medicare.gov: Chiropractic services and Medicare.gov: Acupuncture.