Course of Treatment

Medicare Advantage (MA) members receiving chiropractic services under Medicare-covered medical benefits should expect a course of treatment to affect improvement of, arrest or retard deterioration of a spinal joint condition within a reasonable period of time. Reasonableness depends on whether the subluxation is acute (for example, a strain or sprain) or if it is chronic (involving loss of joint mobility).

Although there are no chiropractic visit limits under the Medicare-covered benefit and the number of visits is determined by medical necessity, if the above criteria are met, up to 12 chiropractic treatments may be allowed without additional review. Additional services must be reviewed to determine the efficacy of therapy.

Coverage is excluded for most other diseases and pathological disorders, such as multiple sclerosis, pneumonia, emphysema, muscular dystrophy, and rheumatoid arthritis. These disorders do not provide therapeutic grounds for chiropractic manipulative treatment.