Is an MRI covered when a chiropractor orders it?
It depends on the plan. Many commercial plans will cover a lower back MRI ordered by a chiropractor, but only with prior authorization and weeks of documented conservative care behind it. Medicare will not pay for it on a chiropractor's order at all. Code 72148 is the standard MRI of the lower back, taken without dye.
Approval first
Usually covered once the plan says yes
Medicare says no
Medicare pays a chiropractor for spinal manipulation only, so an MRI on that order is denied. It has to be reissued by a physician, nurse practitioner or physician assistant.
4 to 6 weeks
Most plans want documented conservative care, often four to six weeks of therapy or adjustments, before they approve the scan. Red flag symptoms are the exception.
Two bills, one MRI
The imaging center bills for the scan and the radiologist bills for reading it. Patients quoted one price get two envelopes and call your desk.
Check, then order
The scan is booked days out, so there is time. Run the plan first and you see the deductible left and the approval flag before the order goes out.
What would a real check show for this patient's 72148?
Pick a sample plan and type your fee. This is the visibility a real-time check gives the desk for every actual patient, in under a second.
Eligibility readout · 72148
Sample- Coverage
- Active, $150 imaging copay
- Frequency
- No limit, prior authorization required
- Patient share
- Type your fee to see it
Estimate from a sample plan. A real check reads the actual plan in under a second.
When 72148 is the right code
- The lower back is the area being imaged
- The scan is done without any contrast dye
- Symptoms held on for weeks despite conservative care
- The order comes from a provider the plan accepts
- Prior authorization is approved before the appointment
Documentation payers expect
Payers want the ordering provider's name and credentials, the diagnosis, and dated notes showing what was tried first and how it went. Keep the approval number with the order, because the imaging center will ask for it.
Why a lower back MRI gets denied
What happens after the MRI
Two bills follow the scan, one from the imaging center and one from the radiologist who reads it. If the MRI shows something, the next stop is usually a spine specialist visit at 99204 or 99214, with its own copay and sometimes its own referral. Chiropractic care often continues alongside, billed as 98941 and 97140. Reading the deductible and the approval flag before the order goes out keeps all of that from landing as a surprise.
72148, quick answers
Will Medicare pay for an MRI my chiropractor ordered?
No. Medicare covers spinal manipulation from a chiropractor and does not pay for imaging or tests a chiropractor orders. The same MRI is usually covered when a physician, nurse practitioner or physician assistant writes the order and the rest of the rules are met.
Why does an MRI need approval first?
Most commercial plans review advanced imaging before it happens and want to see that simpler care was tried. Without that approval on file, the scan is typically billed to the patient instead of the plan.
Do I have to try therapy or adjustments first?
Usually yes. Plans commonly look for four to six weeks of documented conservative care before they approve a lower back MRI, unless the notes show red flag symptoms.
Why did I get two bills for one MRI?
The facility bills for the scan and the radiologist bills separately for reading it. Both run through the deductible and coinsurance, so one approved MRI can still mean two statements.
Would an x-ray be covered instead?
A lower back x-ray, code 72100, costs far less and rarely needs approval, which is why many plans expect it first. Medicare still will not pay for it when a chiropractor is the one ordering.
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Related: 72158 · 72141 · 72100
CPT is a registered trademark of the American Medical Association. This page is Valian's own plain-English summary for front-desk teams, not official CPT descriptor text, and is not billing or clinical advice. Coverage patterns are common plan behaviors; every plan differs. Verify benefits before the visit.