Chiropractic Guidelines

Covered: medically necessary chiropractic services for evaluation, diagnosis, and treatment of neuromusculoskeletal conditions to restore lost function (including E/M, chiropractic manipulative therapy, and physical medicine/rehab); excluded are maintenance/preventive care, non‑neuromusculoskeletal conditions, care without quantified ADL deficits or expected measurable improvement, care that delays other necessary treatment, care given despite unmanaged red‑flag/life‑threatening conditions, or care exceeding medically necessary frequency/duration. Key requirements: documentation must show quantified ADL deficits using recommended standardized tools and demonstrate measurable improvement (MCID/MDC) for continued care, red flags must be evaluated/managed before treatment, and Medicare cases require x‑ray or exam evidence of spinal subluxation for spinal manipulation.

"Medically necessary Chiropractic Services are those that are reasonable and necessary, based on Generally Accepted Standards of Practice, for the evaluation, diagnosis, and treatment of a condition..."