Chiropractic Care in Colorado: A Step-by-Step Guide to Coverage

Chiropractic care in Colorado is regulated under Medicaid (Health First Colorado), Medicare, private insurance rules, and employer-based plans. This guide explains coverage based on your situation and helps you navigate requirements, visit limits, and network rules.

 
Step 1: Determine Your Coverage Type

Medicaid (Health First Colorado)

Colorado’s Medicaid program offers limited chiropractic benefits.

For Adults:

• Chiropractic care is covered when it is deemed medically necessary.
• Services are generally restricted to treatment of neuromusculoskeletal disorders.
• There is an annual visit limit, typically 20 visits per calendar year, unless otherwise authorized.

For Children (Under 21):

• Covered under EPSDT (Early and Periodic Screening, Diagnostic and Treatment).
• No set visit limit; care must be medically necessary.
• Chiropractic treatment must be part of an approved care plan.

What is covered:

• Manual spinal manipulation.
• Evaluation and treatment for spinal-related neuromusculoskeletal issues.

What is not covered:

• Massage therapy.
• Maintenance or wellness-only adjustments without a treatment plan.

Requirements:

• The chiropractor must be an enrolled Health First Colorado provider.
• A diagnosis and treatment plan must be documented.
• Prior authorization may be required for extended care beyond the standard limits.
   

Medicare

Medicare Part B in Colorado follows federal rules:

• Covers only manual spinal manipulation for vertebral subluxation.
• Does not cover X-rays ordered by the chiropractor, massage therapy, or wellness care.
• Patients pay 20 percent of the Medicare-approved amount after meeting the Part B deductible.
• Chiropractors must document medical necessity at every visit.

 
Private Insurance and Marketplace Plans

Colorado has specific rules under the Affordable Care Act benchmark plan requiring musculoskeletal benefits, which includes chiropractic care.

What most plans include:

• Chiropractic adjustments and evaluations when medically necessary.
• Coverage is typically capped between 12 and 20 visits per year.
• Some plans allow more visits if progress is documented.
  Requirements:

Many plans require a referral from a primary care provider.

• Prior authorization may be needed for extended treatment or advanced imaging.
• Coverage applies to in-network chiropractors; out-of-network rules depend on plan type (HMO vs. PPO).

 
Employer and Self-Funded Plans

• Large employer plans often include chiropractic benefits.
• Self-funded plans are not required to follow state mandates, so benefits vary widely.
• Check the Summary of Benefits provided by your employer to confirm coverage and visit limits.
   

Step 2: Understand Network Rules

HMO Plans:

• Chiropractic care must be provided by an in-network chiropractor to be covered.
• Out-of-network visits are only approved if no in-network chiropractor is available and the insurer authorizes the visit.

PPO Plans:

• In-network chiropractors are covered at the best rate.
• Out-of-network chiropractors may be covered at a lower reimbursement rate, and patients may be balance-billed.

Medicaid:

• Only chiropractors enrolled with Health First Colorado are covered.
• Out-of-network providers are not reimbursed.

Medicare:

• Any chiropractor who accepts Medicare assignment is eligible to provide covered services.
• If a chiropractor does not accept assignment, patients may need to pay upfront.
   

Step 3: Apply to Your Situation

If you are a Medicaid member:

• Find a chiropractor who participates in Health First Colorado.
• Get a diagnosis and treatment plan documented.
• Track your visits to stay within the annual limit unless more are approved.

If you are on Medicare:

• Confirm the chiropractor accepts Medicare assignment.
• Make sure the provider documents subluxation and medical necessity.
• Expect 20 percent coinsurance after the deductible.

If you have private insurance:

• Check your plan’s chiropractic benefit section for visit limits and referral requirements.
• Use an in-network chiropractor.
• Ask if pre-authorization is needed for extended care.

If you are uninsured:

• There are no public chiropractic benefits unless you qualify for Medicaid or Medicare.
• Care must be paid for out of pocket.

 
Key Points for Colorado Residents

• Medicaid covers chiropractic services for adults and children with visit limits for adults and expanded EPSDT benefits for children.
• Medicare covers only manual spinal manipulation for subluxation with strict documentation requirements.
• Most private and Marketplace plans include chiropractic care but impose visit caps and require medical necessity.
  In-network chiropractors are critical for full coverage under
• Medicaid and most HMOs.
• PPOs offer more flexibility but often at a higher out-of-pocket cost for out-of-network care.