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Chiropractic Services

Revised: December 31, 2025

· Eligible Providers

· Eligible Members

· 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 Minnesota Health Care Programs (MHCP). To enroll with MHCP and be eligible to provide, bill and be paid for Chiropractic Services, providers must meet the requirements and submit the forms listed on the Chiropractor Enrollment Criteria and Forms webpage.

Eligible Members

Medical Assistance (MA) and MinnesotaCare members under 21 years old 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, 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

· Diagnosis for acute or chronic pain

· 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

· Chiropractic services for members 21 years of age and older.

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 patient 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 before 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 claim type. 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.