Chiropractic Services

Revised: 06-09-2016

Chiropractic services are medically necessary therapies that employ manipulation and specific adjustment of body structures, such as the spinal column, provided by a licensed doctor of chiropractic.

Eligible Providers

Chiropractors licensed under Minnesota law or, where applicable, licensed by the state in which he or she practices are eligible to enroll with MHCP.

Eligible Recipients

Medical Assistance (MA) and MinnesotaCare members are eligible for chiropractic services.

Covered Services

The following are covered chiropractic services:

Benefit Limits

Chiropractic services annual benefit limits include:

An evaluation and management (E/M) service is allowed on the same date of service as a spinal manipulation only if the evaluation and management service is significant and separately identifiable from the procedure that is performed. Use modifier 25 to indicate that the patient’s condition required a significant, separately identifiable E/M service, beyond the usual pre- and post-procedure care associated with the service performed.

Note: Do not use modifier 25 if the documentation shows that the amount of work performed is consistent with that normally performed with the procedure.

Use the most appropriate chiropractic, evaluation and management (E/M) or x-ray code for the service provided as outlined in the billing section below.

Documentation Requirements

Initial Chiropractic Visit
Document the following for the initial chiropractic visit:

Subsequent Visits
Documentation required for subsequent visits include:

Noncovered Services

Authorization Requirements

Authorization is required for any combination of procedure codes 98940, 98941 and 98942 in excess of six per month or 24 per calendar year. Submit the authorization request for only the number of units in excess of the benefit coverage allowed. If your recipient needs eight treatments in a month, your request needs to ask for two additional treatments, not eight.

To request an authorization, use the MHCP MN–ITS Interactive User Guide (PDF) to log in to MN–ITS and submit a MN–ITS Interactive Authorization Request or, submit both the Medical Authorization Form (DHS-4695) (PDF) and the Chiropractic Authorization Form (DHS-4878) (PDF) to the authorization medical review agent.

Authorization Criteria

The diagnosis of subluxation may be demonstrated using x-ray or physical examination. If submitting x-rays (or radiologic report) as documentation of the diagnosis, the x-ray must be no older than 12 months prior to the start of treatment.

Documenting subluxation by physical examination
Use evaluation of musculoskeletal or nervous system to identify the following:

Two of the above criteria are required to demonstrate subluxation based on physical examination. One of these criteria must be:

Whether demonstrating the subluxation by x-ray or physical exam, submit the documentation required for initial visits and subsequent visits to support the authorization request for additional units of care.

Billing

Use MN–ITS 837P Professional. Refer to the MN–ITS User Guide for chiropractic services for claim completion instructions.

Diagnosis Codes

Submit the most applicable ICD diagnosis codes when billing for subluxation on claims.

Payment Limitations

Payment for x-rays is limited to radiological examinations of the full spine:

Legal References

Minnesota Statutes 256B.0625, Subd 8e. (Chiropractic Services)
Minnesota Rules 9505.0245 (Chiropractic Services)
Minnesota Statutes 148.01 to 148.106 (licensing requirements)
42 CFR 440.60(b)

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