It’s a question we hear from frustrated chiropractors often. They are tired of the hassles of Medicare, the threat of audits, the increasing documentation requirements and the low pay.

The rumor mill churns one way and their friends give them advice another way and many chiropractors end up confused in what they actually can and cannot do to reduce Medicare hassles.

And then comes the question:

Can chiropractors get out of Medicare?

Some folks would like to run from Medicare patients and not see them altogether…but aren’t sure if they can do this. Others want to treat Medicare patients – without billing Medicare. Still others wonder if they can charge Medicare patients a different rate, offer a “cash” or “senior” discount.

No matter what the route, chiropractors would like to break free from the chains of Medicare’s low profitability and high requirements towards a more friendly climate.

Oh so many questions.

Answers to Your Chiropractic Medicare Questions

Over the years, I have attempt to answer the age-old question “Can chiropractors get out of Medicare” from a slightly different angles but making the facts as clear as possible.

So, if it’s answers you want, start here:

How Medicare Answers the Question

Just in case you don’t want to take my word for it, perhaps you’d just like to read it from Medicare.  Have it your way and check out these links below:

The Medicare Benefit Policy Manual contains the detailed description and answer to the question “can chiropractors get out of Medicare?” (I think it’s pretty clear but I underlined and bolded the text for you anyway):

40.4 – Definition of Physician/Practitioner (Rev. 62, Issued: 12-22-06, Effective: 11-13-06, Implementation: 04-02-07) For purposes of this provision, the term “physician” is limited to doctors of medicine; doctors of osteopathy; doctors of dental surgery or of dental medicine; doctors of podiatric medicine; and doctors of optometry who are legally authorized to practice dentistry, podiatry, optometry, medicine, or surgery by the State in which such function or action is performed; no other physicians may opt out. Also, for purposes of this provision, the term “practitioner” means any of the following to the extent that they are legally authorized to practice by the State and otherwise meet Medicare requirements: Physician assistant; Nurse practitioner; Clinical nurse specialist; Certified registered nurse anesthetist; Certified nurse midwife; Clinical psychologist; Clinical social worker; Registered dietitian; or Nutrition Professional. The opt out law does not define “physician” to include chiropractors; therefore, they may not opt out of Medicare and provide services under private contract.

Timely Good News About Medicare

There is a bit of good news…if you act soon. While you can’t get out of Medicare, you can change your participation status. Here’s how:

  • Each year, during the last 6 weeks of the calendar year, you have an option of changing your PAR status in Medicare.
  • If you miss this 6 week window, you are stuck with the same status for another year
  • Changing your status does not change the rules, but it does change the reimbursements

To see a detailed discussion of WHY you might want to change your Participation status, see our previous articles for more details:

Final Thoughts and Action Steps

In the end, the question “Can Chiropractors Get Out of Medicare?” has basically been answered for you, but your participation decision has not.

Do your research. Do the math. And make an informed decision based on what you’ve found out from that – not from your buddy, from the rumor mill or from some biased source with an axe to grind. After all, you can only make the decision once per year, so you’ll have to live with the consequences for another 12 months if you fail to do your homework!  


For those of you who may be on the fence about how to strategically plan the best move for your practice in regards to Medicare MACRA, you’ve still got time to join our upcoming webinar Making the Medicare MACRA Decision in 2018.  The webinar is FREE, so we hope you’ll join us!