Chiropractic Scope of Practice in Kentucky: Limits and Penalties

The scope of practice for chiropractors in Kentucky is narrow and defined by statute: they diagnose and treat misalignments of the spinal joints and surrounding tissues using hands-on adjustments and supporting therapies. They cannot prescribe drugs, perform surgery, do acupuncture, treat cancer or contagious diseases, or use radiation as a treatment. Anything outside that spinal focus has to be referred to a medical doctor or other licensed provider.

How Kentucky Defines Chiropractic

Under KRS 312.015, “chiropractic” means diagnosing and adjusting misalignments of the spinal joints and their adjacent tissues. A chiropractor is a person licensed by the Kentucky Board of Chiropractic Examiners (KBCE) to diagnose patients and treat disorders related to those misalignments through adjustment, manipulation, and methods designed to support that treatment.¹

The statute draws a hard line between chiropractic and other health professions. Chiropractic in Kentucky does not include the practice of medicine, osteopathy, podiatry, dentistry, optometry, nursing, or pharmacy. The center of gravity is the spine and the tissues around it, not general healthcare.

Treatments Kentucky Chiropractors Cannot Perform

KRS 312.017 lists six categories of care that are off-limits under any circumstances:¹

Contagious or communicable diseases. Infections, viruses, and other transmissible conditions fall outside the scope.
Cancer. Any form of cancer treatment is prohibited.
Radiation-based treatment. X-rays are allowed for diagnosis only. Using X-ray or other radiological methods to treat a patient is not.
Surgery. No surgical procedures of any kind.
Acupuncture. Kentucky flatly prohibits chiropractors from performing acupuncture, even though some other states permit it.
Prescription drugs or controlled substances. Chiropractors cannot prescribe medications, administer injections, or dispense controlled substances.

Any treatment method not covered by KRS Chapter 312 is also off the table. A chiropractor who treats a patient for a condition outside the defined scope faces disciplinary action from the KBCE, regardless of whether the patient was harmed.

What Chiropractors Can Do

Within the boundaries of KRS 312.015 and 312.017, Kentucky chiropractors examine, diagnose, and treat using methods taught at accredited chiropractic colleges.¹

On the diagnostic side, that includes physical examinations, spinal assessments, neurological evaluations, and diagnostic X-rays. For imaging beyond X-rays, such as MRI or CT scans, a chiropractor can refer the patient to a physician, licensed lab, or licensed health facility to obtain the testing needed to assist with diagnosis.

On the treatment side, spinal manipulation and manual adjustment are the core. Supporting methods commonly used in Kentucky offices include therapeutic ultrasound, electrical muscle stimulation, cold laser therapy, myofascial release, trigger point therapy, rehabilitative exercises, and lifestyle counseling related to musculoskeletal health. Chiropractors can also offer general nutritional guidance and recommend dietary supplements. They cannot recommend anything that qualifies as a drug or controlled substance.

When a Chiropractor Must Refer the Patient Out

Referral is not discretionary in Kentucky. KRS 312.017(3) requires that any patient whose diagnosis falls outside chiropractic scope be referred to a medical doctor or other licensed practitioner.¹ Continuing to treat a patient whose condition needs medical care is both a scope violation and a violation of a specific statutory command.

Chiropractors may also refer patients to physicians, labs, or health facilities for testing that assists with diagnosis, even for conditions that are within their scope. The statute notes that no other provider is required to accept such a referral, so most Kentucky chiropractors work with established referral relationships rather than assuming any physician will take the patient.

Insurance and Coverage Boundaries That Follow the Scope

The narrow scope shapes what insurers will pay for, and that catches both patients and practitioners off guard.

Medicare Covers Only One Chiropractic Service

Medicare Part B pays for exactly one thing a chiropractor does: manual spinal manipulation to correct a vertebral subluxation. It does not cover X-rays, massage therapy, acupuncture, or any other service a chiropractor might order or provide.²

To be paid, documentation must establish four things: that a subluxation exists, that it is connected to the patient’s symptoms, that there is a clear treatment plan with frequency and duration, and that the patient is actually improving. Medicare draws a firm line between “active treatment,” where meaningful improvement is expected, and “maintenance therapy,” which it does not pay for. After the Part B deductible, the patient pays 20% of the Medicare-approved amount.²

Workers’ Compensation Allows Direct Access

Under KRS 342.019, chiropractic services are covered by Kentucky’s workers’ compensation system. An employee injured on the job may choose a licensed chiropractor as the treating provider, and workers’ compensation must pay for the covered services.³ No referral from a medical doctor is required, and the chiropractor can bill workers’ comp directly.

Telehealth Is Limited by the Nature of the Work

KRS 312.220 requires chiropractors who use telehealth to obtain the patient’s informed consent and maintain confidentiality, and it directs the KBCE to develop regulations governing telehealth practice. Because chiropractic treatment is inherently hands-on, telehealth is most relevant for initial consultations, follow-up assessments, and patient education rather than actual spinal manipulation.

Consequences of Practicing Outside the Scope

The KBCE enforces scope through discipline, and Kentucky courts enforce it through criminal law.

Board Discipline

KRS 312.150 authorizes the board to bring charges against any licensed chiropractor. Grounds include fraud in obtaining the license, felony conviction, deceptive patient communications, substance impairment, unethical conduct, violating any board rule, failing to complete required continuing education, and refusing to provide medical records or an itemized statement within 10 business days of a patient’s request.⁴

“Unprofessional conduct” is defined broadly. It covers gross incompetence, performing unnecessary services, charging for services not rendered, misleading fee-collection tactics such as locking patients into treatment contracts, and billing fraud against insurance companies, Medicare, or Medicaid. The board does not need to prove actual patient injury to sustain a charge of unprofessional conduct.

Criminal Penalties

Practicing chiropractic without a license, including practicing after a license has been revoked, is a misdemeanor. KRS 312.991 sets the penalty at a fine of up to $500, up to six months in county jail, or both. Each individual treatment counts as a separate offense, so charges can compound quickly.⁵

The same penalty applies to anyone who buys, sells, or fraudulently obtains a chiropractic diploma or license, or who uses professional titles to suggest chiropractic practice without a license. Any advertisement or signage implying someone is a chiropractor is presumptive evidence of a violation if that person is unlicensed. Beyond the criminal penalty, the KBCE can seek an injunction in Franklin Circuit Court to stop ongoing violations, and that order is enforceable statewide.⁵

1
Kentucky Board of Chiropractic Examiners. Kentucky Revised Statutes Chapter 312 – Chiropractic
2
Medicare.gov. Chiropractic Services
3
Kentucky Legislative Research Commission. Kentucky Revised Statutes 342.019 – Coverage of Chiropractic Services
4
Kentucky Board of Chiropractic Examiners. Kentucky Board of Chiropractic Examiners Laws and Regulations
5
Kentucky Legislative Research Commission. Kentucky Revised Statutes 312.991 – Penalties, Injunction or Restraining Order