Chiropractic Care in California: Full Coverage Map for Patients

California residents have access to chiropractic care through a mix of state laws, federal programs, and private insurance regulations. This guide explains coverage in plain language for Medi-Cal (Medicaid), Medicare, individual and employer plans, and special rules unique to the state.

 
Section 1: Medi-Cal (California Medicaid)

California is one of the states that covers chiropractic care under its Medicaid program, known as Medi-Cal.

Adults:

• Chiropractic care is included as a covered Medi-Cal benefit.
• The service must be medically necessary.
• Manual spinal manipulation is the primary covered service.

Children under 21:

• Covered through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program.
• No set visit limit as long as care is medically necessary.

Limits:

• Medi-Cal generally allows up to two chiropractic visits per month for adults, with more approved if there is documented medical necessity.
• EPSDT has no fixed cap for children.

Requirements:

• The chiropractor must be a Medi-Cal provider.
• A treatment plan and diagnosis must be documented.
• Prior authorization is sometimes needed for extended care.

Not Covered:

• Massage therapy.
• Maintenance-only or wellness care without a medical diagnosis.
   

Section 2: Medicare

Federal Medicare rules apply in California:

• Manual spinal manipulation to correct vertebral subluxation is covered.
• No coverage for X-rays ordered by the chiropractor, massage therapy, or maintenance adjustments.
• Patients pay 20 percent coinsurance after the Part B deductible.
• Chiropractors must document the subluxation and medical necessity.
   

Section 3: Private Insurance and State Regulations

California has some of the strongest state-level mandates for chiropractic coverage.

Mandatory Offering:

• State law requires most health plans regulated by the
• California Department of Managed Health Care to cover chiropractic care as part of musculoskeletal treatment.

Typical Plan Structure:

• Chiropractic visits are covered as medically necessary.
• Coverage usually includes spinal manipulation and related evaluation.

Visit Limits:

• Many plans cover 12–24 visits per year.
• Additional visits require documentation of progress and sometimes prior authorization.

Requirements:

• Most HMOs require a referral from a primary care physician.
• PPOs allow self-referral, but in-network providers are recommended to avoid high out-of-pocket costs.
   

Section 4: Network and Access Rules

HMO Plans:

• You must use an in-network chiropractor.
• A referral from your primary care doctor is typically required.
  Out-of-network visits are not covered unless pre-approved.

PPO Plans:

• You can choose any chiropractor, but in-network care has lower costs.
• Out-of-network providers are covered at a reduced reimbursement level, and balance billing may apply.

Medicare:

• Any chiropractor who accepts Medicare assignment can treat you.
• Without assignment, you may pay upfront and submit for reimbursement.

Medi-Cal:

• Only Medi-Cal-approved chiropractors are paid.
• Out-of-network or non-enrolled chiropractors are not reimbursed.
   

Section 5: What Patients Should Do in California

For Medi-Cal:

• Find a chiropractor who is enrolled as a Medi-Cal provider.
• Get a diagnosis and treatment plan documented.
• If you are a child under 21, use EPSDT for expanded coverage.

For Medicare:

• Choose a chiropractor who accepts Medicare assignment.
• Ensure documentation of vertebral subluxation.

For Private Insurance:

• Check your plan booklet for chiropractic benefits and visit limits.
• Use an in-network chiropractor.
• Get referrals or prior authorizations if required by your plan type.

For PPO Members:

• Weigh the cost difference between in-network and out-of-network providers.
• Ask the provider about potential balance billing.
   

Section 6: Key Points for California Residents

• Medi-Cal covers chiropractic care for both adults and children when medically necessary.
• Medicare covers only manual spinal manipulation for subluxation.
• State law requires most private health plans to include chiropractic benefits.
• Visit limits are common but can be exceeded with proper documentation.
• Using in-network chiropractors is the safest way to ensure payment under both Medi-Cal and private insurance.