Chiropractors (DC) enroll in Medicare using the CMS-855I — the same individual enrollment application as physicians and other practitioners. However, Medicare’s chiropractic coverage is among the most restricted of any provider type. Understanding the limitation before enrolling is critical to avoiding billing compliance problems.
Enrollment basics
- Doctor of Chiropractic degree from an accredited institution
- State licensure as a chiropractor
- Type 1 NPI (individual)
- Enrollment via CMS-855I or PECOS
The chiropractic Medicare limitation
Medicare covers one service from chiropractors: manual manipulation of the spine to correct subluxation.
That’s it. Medicare does not cover:
- X-rays taken by a chiropractor
- Physical therapy services provided by a chiropractor
- Massage therapy
- Nutritional counseling
- Maintenance care (care that maintains current function without expectation of improvement)
- Extremity manipulation
- Any service beyond spinal manipulation
⚠️ Risk flag: Chiropractors are among the most audited Medicare providers precisely because the scope of covered services is so narrow. Billing for services outside this limitation is the leading cause of chiropractor exclusions from Medicare.
Active vs. maintenance care
Medicare covers chiropractic manipulation only when the treatment is active/curative — meaning there is a reasonable expectation of improvement in the patient’s condition. Once the patient has reached maximum therapeutic benefit and further treatment is only maintaining their current status, chiropractic services are no longer covered.
Documentation must establish:
- The patient has a subluxation of the spine
- The subluxation is demonstrated by physical examination findings (and X-ray if applicable, though the X-ray itself is not covered)
- The treatment is expected to result in demonstrable clinical improvement
The ABN (Advance Beneficiary Notice) must be issued when you have reason to believe Medicare will not cover the planned services — this includes maintenance care.
G-code requirements
Chiropractors must use G-codes for chiropractic manipulation services:
- 98940 — spinal manipulation, 1-2 regions
- 98941 — spinal manipulation, 3-4 regions
- 98942 — spinal manipulation, 5 regions
An AT modifier must be applied to indicate the service is for active/curative treatment. Without the AT modifier, Medicare will assume the service is maintenance care and deny it.
Key applications
- CMS-855I — individual enrollment
- CMS-855R — reassignment to group (if applicable)
Ask Mae if you have questions about AT modifier documentation or distinguishing active from maintenance care.