Chiropractic Guidelines

eviCore covers chiropractic examinations, spinal manipulation, adjunctive physiotherapy and emergency chiropractic services for neuromusculoskeletal conditions (including specified cervical, head/neck and select lower‑extremity diagnoses) but excludes services by non‑participating chiropractors except emergencies, preventive/maintenance care, manipulation under anesthesia, most advanced diagnostics and non‑neuromusculoskeletal treatments, services outside plan rules, and other listed exclusions. Coverage requires eviCore authorization and detailed documentation showing significant functional limitation (NDI ≥16% or PSFS average ≤7/10 for three items) and pain ≥3/10 limiting function, a two‑week initial conservative trial with measurable improvement to continue care, objective exam findings, red flag screening, adherence to specified progress benchmarks, and medical‑necessity justification for advanced imaging or extended treatment.

"Services for preventive, maintenance, or wellness care."