Potential Concerns for Chiropractors Regarding H.R. 539 – The Chiropractic Medicare Coverage Modernization Act of 2025
H.R. 539 proposes to expand Medicare (CMS) coverage by recognizing doctors of chiropractic as physicians for Medicare purposes and allowing reimbursement for services within a chiropractor’s state-defined scope of practice. While many in the profession may welcome these changes, principled chiropractors may view several provisions of the bill with concern.
1. Designating Chiropractors as “Physicians”
Recognition as physicians is likely to bring chiropractic under regulatory systems originally developed for medical practice. H.R. 539 will likely require CMS to establish national standards governing chiropractic evaluation, documentation, quality reporting, and medical necessity. Unless the chiropractic profession plays a central role in developing those standards, they will likely be derived from medical models that were never intended to evaluate chiropractic care.
Chiropractic and medicine are distinct professions with different educational models, diagnostic frameworks, clinical objectives, and approaches to patient care. While both professions serve important roles in healthcare, one should not simply be evaluated using the standards developed for the other.
The term “physician” will accelerate the assimilation of chiropractic into a medical framework, diminishing the profession’s separate identity and traditional principles, weakening healthcare options and outcomes for Medicare beneficiaries.
2. Medicare Coverage for All Services Within State Scope of Practice
The bill would allow Medicare reimbursement for services that fall within a chiropractor’s legal scope of practice under each individual state law. This creates an incentive for broader scopes of practice and greater dependence on third-party reimbursement.
Expanded insurance reimbursement leads to increased documentation requirements, coding demands, compliance obligations, and greater federal oversight of clinical decision-making. History suggests that every expansion of Medicare benefits increases administrative requirements.
Additionally, CMS will be forced to determine which services are “reasonable and necessary”. Eventually Medicare—not state law—begins defining chiropractic.
History reveals that Medicare has already defined the practice of Chiropractic: • “maintenance care”
• “active treatment”
• “reasonable and necessary services”
• “documentation expectations”
3. No Medicare Opt-Out Provision
A significant concern is that the legislation does not include an opt-out mechanism similar to that available to medical doctors and certain other healthcare providers. Without an opt-out provision, chiropractors must participate in Medicare, and therefore remain subject to Medicare’s rules and limitations when caring for patients whom have Medicare benefits. This perpetuates an unequal standard and limits professional autonomy.
Conclusion
H.R. 539 represents more than a reimbursement bill; it signals a shift in the profession’s identity and relationship with government healthcare programs. While supporters see expanded access, we view the bill as increasing federal influence and federal costs, encouraging further integration of chiropractic into the medical model, and failing to address long-standing concerns about professional autonomy and the right to opt out of Medicare participation.
