Chiropractic Guidelines

Covered: chiropractic services are allowed only when reasonable and necessary to evaluate, diagnose, and treat neuromusculoskeletal conditions to restore lost function; excluded are maintenance/preventive care, non‑neuromusculoskeletal treatments, care not directly related to the complaint or lacking documented functional deficits/expected measurable improvement, care in the presence of serious red‑flag conditions, care that replaces/delays other necessary treatment, or care provided at excessive frequency/duration — for Medicare, coverage is limited to manual spinal manipulation to correct a subluxation demonstrated by x‑ray or physical exam. Key requirements: clinical documentation must establish current condition and medical necessity, quantify deficits and measurable improvement (MCID/MDC or ADL measures) using validated tools for initial and continuation requests, document exacerbations and return‑to‑baseline expectations, and include mental‑health referral when indicated.