Medicare Coverage for Back Pain and Spine Conditions

Back pain is one of the most common conditions among Medicare beneficiaries -- affecting millions of older adults and accounting for enormous healthcare spending. Medicare covers a wide range of back pain treatments, from conservative physical therapy through spine surgery. Here is what is available.

Imaging:

• X-rays of the spine: Covered under Part B at 20% coinsurance after deductible
• MRI of the spine: Covered under Part B when medically indicated
• CT scan of the spine: Covered under Part B when medically indicated
• Bone scan: Covered when indicated (e.g., suspected fracture or malignancy)

Electrodiagnostic testing:

• EMG (electromyography) and nerve conduction studies: Covered under Part B for evaluating nerve compression (radiculopathy, stenosis)

Specialist consultations:

• Orthopedic surgeon or neurosurgeon consultation: Covered under Part B
• Pain management specialist: Covered under Part B
• Physiatrist (physical medicine and rehabilitation): Covered under Part B

Physical therapy is the cornerstone of conservative back pain treatment and is covered under Part B:

• Evaluation and treatment by a licensed physical therapist
• Therapeutic exercises, manual therapy, modalities
• Home exercise program instruction
• Functional training

Cost: 20% coinsurance after the Part B deductible. Medigap Plan G covers this 20%.

No therapy cap: Medicare eliminated the annual therapy cap in 2018. Coverage continues as long as therapy is medically necessary and the patient is making progress.

Medicare covers chiropractic care -- but only for manual manipulation of the spine to correct subluxation (misalignment). Medicare does not cover:

• X-rays taken by a chiropractor
• Massage therapy
• Acupuncture (except for chronic low back pain -- see below)
• Other chiropractic services beyond spinal manipulation

Cost: 20% coinsurance after the Part B deductible.

Since 2020, Medicare covers acupuncture for chronic low back pain (lasting 12 weeks or more, not attributable to a specific cause):

• Up to 12 sessions in 90 days
• Up to 8 additional sessions if the patient demonstrates improvement
• Maximum 20 sessions per year

Cost: 20% coinsurance after the Part B deductible.

Epidural steroid injections: Covered under Part B for radiculopathy (nerve pain from disc herniation or stenosis). Typically performed in a pain management clinic or outpatient surgery center.

Facet joint injections: Covered under Part B for facet-mediated back pain.

Medial branch blocks and radiofrequency ablation: Covered under Part B for facet joint pain.

Spinal cord stimulator implantation: Covered under Part B/Part A for qualifying patients with chronic back pain who have not responded to conservative treatment.

Cost: 20% coinsurance after the Part B deductible for outpatient procedures. Medigap Plan G covers this 20%.

For patients who do not respond to conservative treatment, Medicare covers spine surgery:

• Discectomy (disc removal for herniated disc)
• Laminectomy (decompression for spinal stenosis)
• Spinal fusion
• Vertebroplasty/kyphoplasty (for compression fractures)

Inpatient surgery (Part A): Part A covers the hospitalization; Part B covers the surgeon's fee.

Outpatient surgery (Part B): Many spine procedures are now performed outpatient -- covered under Part B at 20% coinsurance.

After spine surgery, Medicare covers:

• Inpatient rehabilitation facility (IRF) for qualifying patients
• Skilled nursing facility rehabilitation
• Home health physical therapy (for homebound patients)
• Outpatient physical therapy

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.