Most PPO and many HMO health plans cover chiropractic care, but almost always with limits — a capped number of visits per year, a requirement that the visits be "medically necessary" rather than maintenance care, and sometimes a referral. Whether your specific plan covers it, and how much, comes down to your state and your plan, not chiropractic care in general — so the short answer is "probably something, but check before you book."
Why there's no single answer
Chiropractic care isn't one of the ACA's essential health benefits, so it isn't guaranteed on every plan the way things like emergency care or maternity care are. Whether it's covered — and how generously — depends on:
- Your state's benchmark plan and mandates. Some states require individual/small-group plans to include chiropractic benefits; many don't. This is a different question from Medicare or Medicaid coverage, which work under their own separate rules.
- Your plan type. PPOs tend to cover chiropractic more often and with fewer hoops than HMOs. Some HMOs require a referral from your primary care physician before a chiropractic visit counts as covered.
- Whether the visit counts as "active treatment" or "maintenance." Nearly every plan that covers chiropractic care draws this line: care for a specific, improving condition is covered up to a visit cap; ongoing wellness adjustments once you've plateaued generally aren't.
What's typically covered vs. typically excluded
| Usually covered (up to plan's cap) | Usually excluded |
|---|---|
| Spinal manipulation/adjustment for a documented condition | Maintenance or wellness-only adjustments |
| A set number of visits per year (commonly 12–30, plan-dependent) | Visits beyond the annual cap |
| Medically necessary follow-up while you're improving | Care once you've reached maximum improvement and plateaued |
Ancillary services — massage, spinal decompression, electrical stimulation — are billed and covered separately from the adjustment itself, and coverage for those varies even more than for the core adjustment.
How to actually check your plan
The only reliable way to know what you're covered for is your own plan, not a general guide. Before booking:
- Call the number on your insurance card and ask specifically: "Is chiropractic care covered, how many visits per year, and is a referral required?"
- Ask about CPT codes 98940–98942 (chiropractic manipulative treatment) — this is what most practices bill under, and your insurer can tell you your coverage for those codes directly.
- Ask whether the practice is in-network. An out-of-network visit can still be partially covered on a PPO, but usually at a lower reimbursement rate.
- Ask what "medically necessary" means for your plan — some insurers want a diagnosis code tied to a specific injury or condition, not just "back pain."
Most practices' front desks have also dealt with your insurer before and can often tell you your covered visit count and copay before your first appointment — it's a completely normal question to ask when you book.
If your plan doesn't cover it (or you're uninsured)
Plenty of people pay out of pocket for some or all of their chiropractic care. See How Much Does a Chiropractor Cost Without Insurance? for realistic per-visit pricing and questions to ask about cash rates and payment plans.
Comparing options
Search ChiroFinder to find chiropractors near you, and see How to Choose a Chiropractor for the full vetting checklist once cost and coverage are sorted out.
Frequently asked questions
Do I need a referral to see a chiropractor?
Sometimes. PPOs usually don't require one; some HMOs do. Check with your insurer before booking if you're on an HMO or similar network-restricted plan.
Does insurance cover an initial X-ray?
Varies by plan, and is often billed and adjudicated separately from the adjustment visit itself. Ask your insurer specifically about imaging coverage, not just the adjustment.
Is chiropractic care covered the same way as physical therapy?
Not necessarily — some plans cover them under different visit caps or benefit categories entirely. See Chiropractor vs. Physical Therapist for how the two compare.
What if my insurer denies a claim?
Ask the practice's billing office for the specific denial reason and CPT code — a denial for "maintenance care" versus "missing referral" require different fixes, and many denials are appealable.
This article is for general informational purposes and isn't a substitute for professional medical or financial advice. Read our full Medical & Editorial Disclaimer.
Sources: HealthInsurance.org — Are visits to the chiropractor or physical therapist covered under the ACA?, MoneyGeek — Does Health Insurance Cover Chiropractic Care?, BlueCross Blue Shield of Minnesota — Does Insurance Cover Chiropractic Care?