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Chiropractic Services


Provider Administrative Policy

Section
Provider Information
Policy Date
December 2006
Status/Date
Revised/May 2008

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Chiropractic Services

Covered Services
Coverage of chiropractic services is limited to manual manipulation (by use of the hands) of the spine for correcting a subluxation for acute or chronic active/corrective treatment.

  • Subluxation is defined as a motion segment in which alignment, movement integrity and/or physiological function of the spine are altered although contact between joint surfaces remains intact.

Chiropractors may use manual devices (those that are hand-held with the thrust of the force of the device being controlled manually) in performing manual manipulation of the spine. Blue Cross of Idaho Medicare Advantage plans do not recognize an extra charge for the device itself or allow an additional payment for the use of these devices.

Blue Cross will process claims for active/corrective treatment submitted with CPT codes 98940, 98941 or 98942. Each claim line should include the active treatment (AT) modifier, and the AT modifier must be in the primary position or we will deny the claim as maintenance therapy.

Non-covered Services
Diagnostic or therapeutic services (other than manual manipulation as described above) furnished by a chiropractor, or provided under his/her order, are not covered. This means that if a chiropractor orders, takes or interprets an x-ray, or any other diagnostic test, the x-ray or other diagnostic test can be used to demonstrate subluxation, but Medicare Advantage coverage and reimbursement are not available for those services.

Maintenance therapy is not a covered benefit under Medicare Advantage Plans.

  • Maintenance therapy is defined as a treatment plan that seeks to prevent disease, promote health and prolong and enhance the quality of life, or therapy to stabilize a chronic condition or prevent deterioration.

Claim Submission
Claims for chiropractic services should follow current Medicare guidelines including, but not limited to, the use of appropriate procedure codes, modifiers and diagnosis codes. Please refer to Medicare`s Chiropractic Manual.


Policy History

Date Action Reason
May 2008 Revised Language clarification

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