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Chiropractic Services

Revised: 06-09-2016

  • Eligible Providers
  • Eligible Recipients
  • Covered Services
  • Noncovered Services
  • Authorization Requirements
  • Billing
  • Legal References
  • 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:

  • • Manual spinal manipulation to treat subluxation (incomplete or partial dislocation), determined to be medically necessary by generally accepted chiropractic standards of care
  • • Evaluation and management services for new and established patients
  • • X-rays needed to support a subluxation diagnosis
  • Acupuncture for pain and other specific conditions
  • Benefit Limits

    Chiropractic services annual benefit limits include:

  • • One evaluation per calendar year to determine medical necessity or progress
  • • 24 spinal manipulative treatments (no more than six per month)
  • 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:

  • • Date of initial treatment
  • • History: include the following:
  • • Symptoms causing patient to seek treatment
  • • Family history if relevant
  • • Past health history (general health, prior illness, injuries, or hospitalizations, medications, surgical history)
  • • Mechanism of trauma
  • • Quality and character of symptoms or problem
  • • Onset, duration intensity, frequency, location and radiation of symptoms
  • • Aggravating or relieving factor
  • • Prior interventions, treatment, medications, secondary complaints
  • • Description of presenting condition or complaints, including:
  • • Mechanism of trauma
  • • Quality and character of symptoms or problem
  • • Onset, duration intensity, frequency, location, and radiation of symptom
  • • Aggravating or relieving factors
  • • Prior interventions, treatment, medications, secondary complaints
  • • Symptoms causing patient to seek treatment
  • • Evaluation of musculoskeletal or nervous system through physical examination
  • • Diagnosis: subluxation must be the primary diagnosis
  • • Treatment plan which includes:
  • • Recommended level of care
  • • Specific treatment goals
  • • Objective measures to evaluate effectiveness of treatment
  • Subsequent Visits
    Documentation required for subsequent visits include:

  • • History
  • • Review of chief complaint
  • • Changes since last visit
  • • System review, if relevant
  • • Physical exam
  • • Exam of area of spine involved in diagnosis
  • • Assessment of change in patient condition since last visit
  • • Evaluation of treatment effectiveness
  • • Documentation of treatment provided on day of visit
  • Noncovered Services

  • • Acupressure
  • • Laboratory services
  • • Medical supplies or equipment supplied or prescribed by a chiropractor
  • • Physiotherapy modalities including:
  • • Diathermy
  • • Ultrasound
  • • Treatment for a neurogenic or congenital condition not related to a diagnosis of subluxation
  • • Vitamins or nutritional supplements or counseling
  • • X-rays, other than those needed to support a diagnosis of subluxation
  • 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:

  • • Pain or tenderness evaluated in terms of location, quality and intensity
  • • Asymmetry or misalignment identified on a sectional or segmental level
  • • Range of motion abnormality (changes in active , passive and accessory joint)
  • • Tissue, tone changes in the characteristics of contiguous, or associated soft tissues, including skin, fascia, muscle, and ligament
  • Two of the above criteria are required to demonstrate subluxation based on physical examination. One of these criteria must be:

  • • Asymmetry or misalignment, or
  • • Range of motion abnormality
  • 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.

    Chiropractic Services

    Codes

    Brief Description

    98940

    Chiropractic manipulative treatment (CMT); spinal, one to two regions

    98941

    Spinal, three to four regions

    98942

    Spinal, five regions


    Evaluation and Management Services

    Codes

    Description

    99201

    Office or other outpatient visit for the evaluation and management of a new patient, requiring 3 key components; 10 minutes face-to-face with patient

    99202

    Office or other outpatient visit for the evaluation and management of a new patient, requiring 3 key components; 20 minutes face-to-face with patient

    99203

    Office or other outpatient visit for the evaluation and management of a new patient, requiring 3 key components; 30 minutes face-to-face with patient

    99211

    Office or other outpatient visit for the evaluation and management of an established patient. Presenting problem(s) are minimal. 5 minutes performing these services

    99212

    Office or other outpatient visit for the evaluation and management of an established patient, requiring 2 of 3 key components; Presenting problems are self-limiting or minor; 10 minutes face-to-face with the patient.

    99213

    Office or other outpatient visit for the evaluation and management of an established patient, requiring 2 of 3 key components; Presenting problems are of low to moderate severity; 15 minutes face-to-face with the patient.


    X-ray Codes

    X-ray Codes

    Brief Description

    X-ray Codes

    Brief Description

    72010

    Full Spine

    72020

    Spine, Single View

    72040

    Cervical

    72050

    Cervical, Min. 4 Views

    72052

    Cervical Complete

    72069

    Thoracolumbar, standing

    72070

    Thoracic, A & P

    72072

    Thoracic, 3 views

    72074

    Thoracic, Comp. Obl 4 Views

    72080

    Thoracolumbar, A & P

    72090

    Scoliosis Study

    72100

    Lumbosacral, A & P

    72110

    Lumbosacral, Comp.Obl

    72114

    Lumbosacral, Comp. Bld.

    72120

    Lumbosacral, Bending

    72170

    Pelvis

    72190

    Pelvis, Comp. Min 3 Views

    72200

    Sacroiliac Joints

    72202

    Sacroiliac, 3 or more views

    72220

    Sacrum & Coccyx Min 2


    Payment Limitations

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

  • • Cervical
  • • Thoracic
  • • Lumbar
  • • Lumbosacral
  • • Pelvis
  • • Sacroiliac joints
  • 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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