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Coverage criteria policies

Chiropractic Services - Minnesota Health Care Programs

These services may or may not be covered by all HealthPartners plans. Please see your plan documents for your own coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Providers must follow prior authorization procedures as outlined in their contract with Fulcrum Health.

Coverage

Chiropractic services are medically necessary therapies that employ manipulation and specific adjustment of body structures such as the spinal column, provided by a licensed doctor of chiropractic.

Chiropractic services are generally covered for the treatment of acute musculoskeletal conditions subject to the indications listed below and per the benefits/limitations outlined in your plan documents

Indications that are covered

  1. Manual spinal manipulation to treat subluxation (incomplete or partial dislocation), determined to be medically necessary by generally accepted chiropractic standards of care
  2. Evaluation and management services for new and established patients
  3. X-rays needed to support subluxation diagnosis (x-rays are not required to support the subluxation diagnosis)
  4. Acupuncture for chronic pain and other specific conditions (please see related content at the right for link to Acupuncture policy)

Indications that are not covered

  1. Acupressure
  2. Laboratory services
  3. Medical supplies or equipment supplied or prescribed by a chiropractor
  4. Physiotherapy modalities including:
    1. Diathermy
    2. Ultrasound
  5. Treatment for a neurogenic or congenital condition not related to a diagnosis of subluxation
  6. Vitamins or nutritional supplements or counseling
  7. X-rays, other than those needed to support a diagnosis of subluxation

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.

References

  1. Coverage criteria are taken directly from the Minnesota Health Care Programs Provider Manual-Chiropractic Services-Revised 6/9/2016 http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=ID_008952

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Policy activity

  • 01/01/1994 - Date of origin
  • 01/01/2017 - Effective date
Review date
  • 12/2017
Revision date
  • 03/23/2016

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