Chiropractic Guidelines

EviCore covers chiropractic evaluation, manipulation, adjunctive physiotherapy and emergency chiropractic services for specified cervical and related musculoskeletal conditions (e.g., cervical radiculitis, disc displacement, cervicalgia, cervicogenic headache) when medically necessary and authorized, while excluding nonparticipating/out-of-area/non‑authorized services (except emergencies), routine/maintenance care, automobile/workers' compensation cases, experimental therapies, most DME and advanced diagnostics unless prior‑authorized. Coverage requires documented significant functional limitation and pain ≥3/10, condition‑specific objective findings (e.g., negative neuro exam with impaired ROM or documented radicular signs), completion of defined conservative trial periods with measurable improvement thresholds (typical 2–4 week initial trial with ~50% improvement by weeks 2–4 and ~75% by weeks 5–8), and prior authorization/referral for imaging, extended care or if red flags/inadequate progress are present.