H.R. 539: Chiropractic Medicare Coverage Modernization Act of 2025

Medicare's chiropractic rules have barely changed since 1972. Today the program recognizes a chiropractor only to correct a "subluxation" through manual manipulation of the spine. That's the one service Medicare pays for. Everything else a chiropractor can do under state law — exams, other treatments, evaluations — Medicare doesn't touch.

H.R. 539 swaps out that narrow language. A doctor of chiropractic would be recognized as a physician under Medicare for any function the state license allows. In practice, coverage would match whatever a chiropractor is authorized to do in the state where the service is delivered.

Scope of practice isn't uniform across states. Some grant chiropractors broader authority; others keep it narrow. So covered services under H.R. 539 would vary by zip code. Supporters — including sponsor Rep. Gregory Steube (R-FL) and 152 cosponsors — argue the bill brings Medicare in line with the VA, the Department of Defense, federal employee health plans, and most private insurers, which the bill's findings say already cover a wider chiropractic scope.

There's one new string attached. For most newly covered services, the chiropractor would have to complete a one-time HHS-designed educational documentation webinar before Medicare pays. The exception: manual spinal manipulation to correct a subluxation — the existing covered service — stays payable without the webinar. The setup reads like Congress wants to widen the door while adding a light paperwork check.

Neurosurgery groups and some physician specialty associations oppose the bill. The American Association of Neurological Surgeons signed onto a letter arguing it expands Medicare coverage for non-MD providers without enough evidence or medical oversight. Expect that fight to sharpen if H.R. 539 moves in Energy and Commerce or Ways and Means, the two committees now holding it.

CBO hasn't released a public cost score. Any Medicare Part B spending increase depends on how many chiropractors bill for the expanded services, which services qualify under each state's license, and how often patients use them. State-by-state variation adds another layer CMS would have to police.