Chiropractic Guidelines

eviCore covers medically necessary chiropractic services (initial exams, spinal manipulation, adjunctive physiotherapy, and emergency care) for listed neuromusculoskeletal conditions but excludes services by non‑participating providers (except emergencies/plan‑authorized), non‑preauthorized care (except initial visits/emergencies), many non‑chiropractic/maintenance/wellness items, and limits imaging/advanced diagnostics to medical necessity with plan authorization. Coverage requires documented medical necessity with validated functional impairment (e.g., NDI), pain ≥3/10 limiting function, absence of red flags, objective exam findings, mandated progress/outcome documentation with specific improvement benchmarks (≥50% by weeks 2–4, ≥75% by week 8, reduced frequency by week 12), otherwise care may be denied or referred.

"Examinations (covered chiropractic service)"