Medicare / Medicaid

Medicaid

  • ACO is not a Medicaid provider 

Medicare

  • Medicare does cover chiropractic care, but it has limitations
  • Medicare only covers chiropractic manipulation (an adjustment)
  • Medicare no longer covers physical medicine procedures and patient exams performed by a chiropractor

 Note:

Much of the ACO treatment plan includes those procedures not covered by medicare. A Supplemental Policy will also not cover these procedures (it is designed to provide additional coverage for those services that are covered by Medicare). A Secondary Policy may offer payment however, this will depend on the type of policy and the coverage you have. Our office staff will help you determine the specifics of your plan.  

Due to the above limitations and the nature of the services ACO provides expect to incurr an out-of-pocket expense for procedures not covered by Medicare and Supplemental or Secondary Policies.

Overview of Medicare Coverage and Chiropractic Services

  1. Medicare does not cover the cost of X-Rays if performed in a chiropractor’s office.
  2. In most cases, Medicare covers a percentage of chiropractic manipulation of the spine, but does not cover therapy, supports, supplements, x-rays, examination or other services offered in a chiropractic office.
  3. Medicare or your Medicare carrier usually allows a limited number of office visits for spinal manipulation per year. The number of visits can be determined by the type and severity of the condition. The patient is responsible for the charges on any visits exceeding any Medicare limits.
  4. Medicare or the Medicare carrier covering your case may also rule that the type of treatment, in their opinion was “medically unnecessary.” You as a patient, need to understand that the chiropractic office or the provider has no control over the decision made by the Medicare carrier. In fact, the chiropractic office or provider does not learn of the denial of your claim until several treatments have already been rendered. If this should happen, and we feel additional care is needed, we will discuss your case with you on an individual basis to help resolve this matter.
  5. Medicare has limited maintenance therapy. Medicare has defined maintenance therapy as; A treatment plan that seeks to prevent disease, promote health and prolong and enhance the quality of life, or therapy that is performed to maintain or prevent deterioration of a chronic condition is not a Medicare Benefit. Once the maximum therapeutic benefit has been achieved for a given condition, ongoing maintenance therapy is not considered to be medically necessary under the Medicare program.