Chiropractic Guidelines

CMT and related chiropractic therapies are covered only when reasonable and necessary to evaluate, diagnose, and treat neuromusculoskeletal conditions to restore lost function and are explicitly excluded for maintenance/preventive care, non‑neuromusculoskeletal disorders, red‑flag conditions, lack of quantified ADL deficits, duplicative or excessive services, or when they replace/delay other necessary care. Key requirements: documentation must verify date/service and correct coding, the number of CMT regions treated, timed‑unit rules, and standardized outcome measures showing quantified functional deficits and clinically meaningful improvement (MCID/MDC or ADL gains) for initial and continuation requests, with Medicare‑specific subluxation evidence when applicable.

"The documented service fulfills the minimum requirements of the description of the Procedure Code that is in effect on the date of service the procedure was performed."