Georgia Medicare chiropractic services come down to a single covered treatment: manual manipulation of the spine to correct a subluxation. Medicare does not pay for the chiropractor's exam, x-rays, massage, physiotherapy, acupuncture, or nutritional advice, even when those services are medically reasonable. For Georgia beneficiaries, that single rule is the difference between a covered visit and a surprise out-of-pocket bill, and this guide explains exactly what Medicare pays, what it never pays, and how to keep your costs predictable.

In This Guide

Why Georgia Medicare chiropractic services coverage is narrow

Manual manipulation of the spine to correct a subluxation. That single phrase is the entire Medicare chiropractic benefit. Everything else a chiropractor might do during a visit, from the initial examination to the x-ray to the post-adjustment massage to the supplement recommendation, falls outside what Medicare pays for. A Georgia beneficiary who walks in expecting comprehensive coverage often leaves surprised when the front desk presents a separate bill for everything except the manipulation itself.

This structure is not accidental. It dates to a compromise reached in 1972, when Congress added chiropractors to Medicare through Section 273 of the Social Security Amendments of 1972 (Public Law 92-603). At the time, the medical and chiropractic professions were locked in a long dispute over whether chiropractic care was a legitimate health service. Congress resolved it by recognizing chiropractors as Medicare providers but limiting coverage to the one service the profession itself identified as its core practice: manual spinal manipulation to correct subluxation. The compromise, codified at Section 1861(r)(5) of the Social Security Act, has remained essentially unchanged for more than 50 years.

The HHS Office of Inspector General has documented for two decades that a substantial share of Medicare-paid chiropractic claims do not meet coverage requirements, typically because of missing or inadequate subluxation documentation, missing AT modifiers, or services billed during maintenance-therapy phases. As a result, chiropractic remains one of the highest-audit-risk specialties in Medicare, and Palmetto GBA, the Medicare Administrative Contractor for Georgia, routinely conducts prepayment and postpayment review of chiropractic claims.

For Georgia beneficiaries, the practical consequence is simple: understanding the Section 1861(r)(5) limitation before you sit down in the chair is the single best way to avoid unexpected out-of-pocket costs.

The federal framework: Section 1861(r)(5) and 42 CFR 410.22

Section 1861(r) defines who counts as a physician

Section 1861(r) of the Social Security Act, titled "Physician," establishes who Medicare recognizes as a physician for Part B purposes. It enumerates five categories of provider.

Section Category
1861(r)(1) Doctor of medicine or doctor of osteopathy
1861(r)(2) Doctor of dental surgery or dental medicine
1861(r)(3) Doctor of podiatric medicine
1861(r)(4) Doctor of optometry
1861(r)(5) Chiropractor

Section 1861(r)(5) recognizes a chiropractor "who is licensed as such by the State... but only with respect to treatment by means of manual manipulation of the spine (to correct a subluxation)." That final clause is the source of the entire coverage limitation. While the other physician categories are recognized for the full scope of their practice, chiropractors are recognized only for one specific service.

42 CFR 410.21 and 410.22: who qualifies and what is covered

CMS implements Section 1861(r)(5) through 42 CFR 410.21 and 410.22. To qualify, a chiropractor must be licensed or legally authorized by the state in which the services are furnished and must satisfy a uniform minimum standard of education. In Georgia, licensed chiropractors graduate from programs accredited by the Council on Chiropractic Education (commonly Life University in Marietta, Sherman College in South Carolina, or Palmer College in Iowa), so the educational standard is uniformly met.

Under 42 CFR 410.21, Medicare Part B pays only for a chiropractor's manual manipulation of the spine to correct a subluxation, and it does not pay for x-rays or other diagnostic or therapeutic services furnished or ordered by a chiropractor. The CMS Benefit Policy Manual (Chapter 15) lists the excluded services in full: laboratory tests, x-rays, office visits and examinations, physiotherapy, traction, supplies, injections, drugs, diagnostic studies (including EKGs), acupuncture, orthopedic devices, and nutritional supplements and counseling. The beneficiary is responsible for 100% of any of these non-covered services.

This exclusion is absolute and turns on the provider, not the service. The same x-ray ordered by an M.D. or D.O. would be covered under the diagnostic radiology benefit; the same x-ray ordered by a chiropractor is not. Physical therapy furnished by a qualified physical therapist is covered; identical-looking therapy furnished by a chiropractor is not.

Documenting a subluxation: NCD 240.1.3 and PART

How NCD 240.1.3 defines a subluxation

National Coverage Determination 240.1.3 defines a subluxation as a motion segment in which the alignment, movement integrity, or physiologic function of the spine is altered, although contact between the joint surfaces remains intact. That last point, intact joint contact, distinguishes a chiropractic subluxation from an orthopedic dislocation, in which the joint surfaces separate completely.

For Medicare coverage, the subluxation must be identified at a specific spinal level, documented, linked to the patient's symptoms, and addressed by the manipulation furnished.

Method one: x-ray demonstration

The subluxation may be documented by an x-ray showing visible misalignment, taken reasonably close to the start of treatment: generally within 12 months before the first day of treatment, or within 3 months after treatment begins. The chiropractor does not have to take the x-ray; it can come from any source, such as a prior image taken by a primary care physician. But Medicare does not pay for the x-ray when a chiropractor orders or performs it, so the beneficiary or another payer covers the imaging itself.

Method two: physical examination (PART criteria)

Alternatively, the subluxation may be documented by physical examination using the PART criteria.

Letter Criterion Examples
P Pain or tenderness Location, quality, and intensity of pain
A Asymmetry/misalignment Sectional or segmental misalignment found on palpation
R Range of motion abnormality Decreased or increased active, passive, or accessory motion
T Tissue/tone changes Changes in skin, fascia, muscle, or ligament characteristics

The chiropractor must document at least two of the four criteria, and at least one of the two must be asymmetry/misalignment (A) or range-of-motion abnormality (R). Pain plus tissue-tone changes alone is not enough. The documentation must be present in the record before each manipulation and must show the subluxation continues throughout the treatment course. NCD 240.1.3 also requires a written treatment plan with the recommended level of care, specific goals, and objective measures of effectiveness.

The AT modifier and active vs. maintenance treatment

The distinction between active treatment and maintenance therapy is the single most consequential coverage rule and the source of the highest volume of chiropractic denials.

Medicare covers active or corrective treatment: care for an acute subluxation, a documented exacerbation of a chronic subluxation, or treatment expected to produce measurable improvement in a reasonable timeframe. Medicare does not cover maintenance therapy: continued care after maximum therapeutic benefit has been reached, care aimed only at preventing recurrence, or "tune-up" and "wellness" visits. Once care becomes maintenance, the chiropractor should obtain a signed Advance Beneficiary Notice (ABN) before billing the beneficiary.

To enforce this line, CMS requires the AT (Active Treatment) modifier on every Medicare-billed chiropractic claim. The chiropractor uses it to certify that the service is active, corrective treatment rather than maintenance care. Claims for CPT 98940, 98941, or 98942 submitted without the AT modifier are treated as maintenance therapy and denied automatically, without human review. A chiropractor who applies the AT modifier without supporting documentation risks audit recoupment, penalties, and program exclusion.

CPT codes and what Georgia Medicare chiropractic services cost

Chiropractic manipulative treatment is reported with a small set of CPT codes that escalate by the number of spinal regions treated. For coding purposes the spine is divided into five regions: cervical, thoracic, lumbar, sacral, and pelvic.

Code Description Coverage
98940 Chiropractic manipulative treatment, spinal, 1-2 regions Covered
98941 Chiropractic manipulative treatment, spinal, 3-4 regions Covered
98942 Chiropractic manipulative treatment, spinal, 5 regions Covered
98943 Chiropractic manipulative treatment, extraspinal, 1 or more regions Not covered

The chiropractor codes based on the regions actually manipulated and documented. CPT 98943 covers extraspinal regions (the head, upper and lower extremities, rib cage, and abdomen); because Section 1861(r)(5) limits coverage to manipulation of the spine, 98943 is statutorily excluded regardless of medical necessity. For non-covered services like 98943, the chiropractor should obtain a signed ABN before furnishing the service.

What the covered manipulation costs

Chiropractic manipulation is paid under the Medicare Physician Fee Schedule, and the approved amount varies slightly between Georgia's Atlanta locality and the rest-of-state locality. For the covered manipulation, once the beneficiary meets the annual Part B deductible of $283 in 2026, Medicare pays 80% of the approved amount and the beneficiary pays the remaining 20% coinsurance.,

Most standardized Medigap (Medicare Supplement) plans cover the 20% Part B coinsurance in full, so a beneficiary with one of those letters typically pays little or nothing out of pocket for the manipulation itself. Three letters work differently: Plan K covers 50% of the Part B coinsurance and Plan L covers 75%, leaving you responsible for the rest, and Plan N covers it in full but charges a copayment of up to $20 for some office visits., Check which letter you hold before assuming the manipulation costs you nothing. Medigap does not, however, pay for the non-covered services (x-rays, exams, maintenance therapy, or extraspinal manipulation), which remain the beneficiary's full responsibility.

Participating, non-participating, and opt-out chiropractors

How much you pay depends heavily on the chiropractor's participation status. Under Medicare's physician-payment rules, providers fall into three categories.

  • Participating (accepts assignment on every claim). The chiropractor is paid the full fee schedule amount, bills you only the deductible and 20% coinsurance, submits the claim directly to Medicare, and cannot bill more. This is the lowest-cost option.
  • Non-participating. The non-participating fee schedule amount is 95% of the participating amount. A non-participating chiropractor may accept assignment claim by claim; when they do not, they may bill you up to the limiting charge, which is 115% of the non-participating fee schedule amount, and Medicare reimburses you (not the chiropractor) its share. Even with Medigap you may pay more here than with a participating provider, because Medigap does not cover amounts above the Medicare-approved charge.
  • Opt-out. An opt-out chiropractor has filed an affidavit declining Medicare payment and requires you to sign a private contract before treatment. Medicare pays nothing, Medigap pays nothing, and you are responsible for the full cost. Opt-out is generally binding for two years.

To find a participating Medicare chiropractor in Georgia, use the "Find a Provider" tool at Medicare Care Compare and filter for chiropractors who accept Medicare assignment, call 1-800-MEDICARE for listings, and confirm each office's assignment status before your visit, since status can change.

Medicare Advantage chiropractic benefits

Medicare Advantage (MA) plans must cover everything Original Medicare covers (the manual spinal manipulation), and many add supplemental chiropractic benefits that fill the gaps Original Medicare leaves. Depending on the plan, those extras can include coverage for routine chiropractor examinations, chiropractor-ordered x-rays, additional visits, extraspinal manipulation (CPT 98943), a flat per-visit copay instead of 20% coinsurance, and sometimes related therapies such as acupuncture or massage.

Benefit structures vary substantially from plan to plan and change year to year, so before enrolling, read the plan's Evidence of Coverage, confirm the chiropractor is in network, and check the annual visit limit and any prior-authorization rules. The GeorgiaCares State Health Insurance Assistance Program (SHIP) at 1-866-552-4464 offers free counseling to compare plans during the Annual Election Period (October 15 to December 7).

Georgia licensure under O.C.G.A. §43-9

Title 43, Chapter 9 of the Official Code of Georgia Annotated governs chiropractic practice in the state. Under O.C.G.A. §43-9-16, Georgia chiropractors may perform spinal adjustments, conduct physical examinations, order and interpret x-rays, provide nutritional counseling, recommend exercise and rehabilitation, use physiotherapeutic modalities, and perform extraspinal manipulation. They may not prescribe drugs, perform surgery, practice obstetrics, or use injection therapy.

The key point for beneficiaries is that Georgia's state scope of practice is much broader than what Medicare covers. A Georgia chiropractor can lawfully order an x-ray or provide nutritional counseling; Medicare simply will not pay for those services when a chiropractor furnishes or orders them. The chiropractor must therefore bill the beneficiary or seek payment from Medicare Advantage supplemental benefits or secondary insurance.

The Georgia Board of Chiropractic Examiners administers licensure under O.C.G.A. §43-9-2 and handles consumer complaints about chiropractor conduct. It can be reached at 237 Coliseum Drive, Macon, GA 31217, or 478-207-2440. Complaints about scope or ethics violations go to the Board; complaints about Medicare billing fraud go to Medicare or the HHS Office of Inspector General.

Resources for Georgia beneficiaries

The narrow Section 1861(r)(5) benefit is easy to misjudge, so a little confirmation up front prevents most surprise bills: ask whether the chiropractor accepts Medicare assignment, ask for an ABN before any service that may not be covered, and lean on free counseling when a Medicare Advantage plan might close the gaps.

Frequently Asked Questions

Does Medicare cover chiropractic care?

Medicare Part B covers one chiropractic service: manual manipulation of the spine to correct a subluxation. Section 1861(r)(5) of the Social Security Act and 42 CFR 410.21 limit coverage to this single service. Medicare does not cover a chiropractor's examinations, x-rays, physiotherapy, acupuncture, massage, nutritional counseling, or maintenance care.

What is a subluxation, and how is it documented for Medicare?

NCD 240.1.3 defines a subluxation as a motion segment in which the spine's alignment, movement, or physiologic function is altered while contact between the joint surfaces remains intact. It can be documented by an x-ray showing misalignment (taken within 12 months before or 3 months after treatment starts) or by a physical exam documenting at least two of the four PART criteria (Pain, Asymmetry, Range of motion, Tissue tone), one of which must be Asymmetry or Range of motion.

What is the AT modifier, and why does it matter?

The AT (Active Treatment) modifier must appear on every Medicare-billed chiropractic claim. The chiropractor uses it to certify that the service is active, corrective treatment rather than maintenance care. Claims for CPT 98940, 98941, or 98942 submitted without the AT modifier are treated as maintenance therapy and denied automatically.

What is the difference between active treatment and maintenance therapy?

Active treatment addresses an acute or exacerbated condition and is expected to produce measurable improvement. Maintenance therapy maintains the status quo or prevents recurrence after maximum therapeutic benefit has been reached. Medicare covers active treatment; it does not cover maintenance therapy.

Are chiropractor-ordered x-rays and exams covered?

No. 42 CFR 410.21 and the CMS Benefit Policy Manual exclude x-rays, office visits, and examinations from coverage when a chiropractor orders or performs them. The same x-ray ordered by an M.D. or D.O. would be covered under the diagnostic radiology benefit, but one ordered by a chiropractor is not.

What do the CPT codes mean, and which are covered?

CPT 98940 covers manipulation of 1-2 spinal regions, 98941 covers 3-4 regions, and 98942 covers all 5 regions; all three are covered. CPT 98943 covers extraspinal manipulation (shoulder, hip, knee, rib, abdomen) and is not covered, because the benefit is limited to manipulation of the spine.

How much does Medicare chiropractic manipulation cost?

After you meet the annual Part B deductible of $283 in 2026, Medicare pays 80% of the approved amount for the covered manipulation and you pay the remaining 20% coinsurance., Most standardized Medigap plans cover that 20% in full, so with one of those letters you typically owe little or nothing for the manipulation itself. Plan K is an exception that covers 50% of the Part B coinsurance and Plan L covers 75%, and Plan N covers the coinsurance in full but charges a copayment of up to $20 for some office visits.,

What is the limiting charge?

The limiting charge is 115% of the Medicare non-participating fee schedule amount. A non-participating chiropractor who does not accept assignment may bill you up to that amount but no more, and Medicare reimburses you its 80% share of the approved amount.

What does it mean if a chiropractor has opted out of Medicare?

An opt-out chiropractor has filed an affidavit declining Medicare payment and requires you to sign a private contract before treatment. Medicare pays nothing and Medigap pays nothing for services from an opt-out chiropractor, so you are responsible for the full cost. Opt-out is generally binding for two years.

Can Medicare Advantage cover more than Original Medicare?

Yes. Medicare Advantage plans must cover everything Original Medicare covers and may add supplemental benefits, such as coverage of examinations, x-rays, extraspinal manipulation, additional visits, and a flat copay instead of 20% coinsurance. Benefits vary by plan, so review the Evidence of Coverage before enrolling.

Can I appeal a denied chiropractic claim?

Yes. Original Medicare has five appeal levels: redetermination by the Medicare Administrative Contractor (within 120 days of your Medicare Summary Notice), reconsideration by a Qualified Independent Contractor, a hearing before an Administrative Law Judge (which for 2026 requires at least $200 in controversy), review by the Medicare Appeals Council, and judicial review in federal court (which for 2026 requires at least $1,960 in controversy).

How do I find a participating Medicare chiropractor in Georgia?

Use medicare.gov/care-compare and filter for chiropractors who accept Medicare assignment, call 1-800-MEDICARE, and ask any office directly. Confirm participation status before each visit, because it can change.

Disclaimers

This guide is educational and is not legal, medical, billing, or coverage advice. The authoritative sources for Medicare chiropractic coverage are Section 1861(r)(5) of the Social Security Act, 42 CFR 410.21 and 410.22, and NCD 240.1.3. Coverage determinations are made by the Medicare Administrative Contractor (Palmetto GBA for Georgia) based on the documentation submitted with each claim. For specific questions, contact Medicare at 1-800-MEDICARE, Palmetto GBA at 1-877-567-9230, or GeorgiaCares SHIP at 1-866-552-4464.

Beneficiaries in Medicare Advantage plans should consult their plan's Evidence of Coverage for chiropractic supplemental benefits, network rules, prior-authorization requirements, and cost-sharing, which vary by plan and can change year to year. Chiropractor licensure and scope of practice in Georgia are governed by O.C.G.A. §43-9; the Georgia Board of Chiropractic Examiners (478-207-2440) is the authoritative source for licensure and conduct questions. Coverage rules and payment amounts reflect federal Medicare policy for 2026 and may change through future rulemaking or contractor determinations; verify current rules at the time of service.

Key contacts for Georgia Medicare chiropractic questions

  • Medicare: 1-800-MEDICARE (1-800-633-4227)
  • Palmetto GBA (Georgia Medicare Administrative Contractor): 1-877-567-9230
  • GeorgiaCares SHIP (free Medicare counseling): 1-866-552-4464
  • Georgia Board of Chiropractic Examiners: 478-207-2440
  • HHS OIG Fraud Hotline: 1-800-HHS-TIPS (1-800-447-8477)
  • Georgia Office of the Attorney General, Consumer Protection: 404-651-8600

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Find personalized help understanding Medicare chiropractic coverage in Georgia at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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