Medicaid Benefit Information

 

Benefit: Chiropractor

Definition:  A chiropractor is a complementary and alternative medicine health care professional who diagnoses and treats mechanical disorders of the spine and muscle system with the intention of improving health. Chiropractic services use manual treatments including spinal adjustment and other joint and soft-tissue manipulation. Chiropractic services include a new patient visit, follow-up manipulations of the spine, and spinal x-rays by a licensed, Medicaid participating chiropractor. The new patient visit consists of a screening and any required manipulation of the spine.

Limits: Medicaid reimbursement for chiropractic services is limited to one visit to a Medicaid authorized chiropractor, per recipient, per day.

A new patient visit is limited to one per provider, per recipient. A new patient is one who has not received any professional services from the provider or provider group within the past three years.

Visits are limited to a total of 24 medically necessary and appropriate visits during a calendar year.

Medicaid does not reimburse massage or heat treatments.

Exceptions:  The provider may request authorization to provide more than the 24 medically necessary visits for recipients 20 years of age or younger.

Co-pays: $1 copay for chiropractic services, per provider, per day, unless the beneficiary is exempt.

Reform items that can vary: # of visits can be limited; total annual amount can be limited; and co-pays can vary