Chiropractic Guidelines

Covered: chiropractic services (CMT, E/M, modalities, therapeutic procedures) are medically necessary only to diagnose, evaluate, or treat significant neuromusculoskeletal conditions that cause quantified deficits in Activities of Daily Living and are expected to produce measurable functional improvement; excluded are maintenance/preventive care, non-neuromusculoskeletal conditions, duplicative or non‑therapeutic services, treatments contraindicated by serious conditions, and care without quantified deficits or expected improvement. Key requirements: documentation must meet the specific procedure code description (use the most specific code), record face‑to‑face/time-based unit rules, identify CMT regions treated, and demonstrate clinically meaningful improvement using validated measures (MCID/MDC) for initial and continued care (Medicare spinal manipulation requires demonstrated subluxation by x‑ray or exam).

"Treatment that does not have a direct therapeutic relationship to the region of complaint is not medically necessary."