CurrentColorado Rocky Mountain Health PlansPolicy CS076.P

Manipulative Therapy – Community Plan Medical Policyopen_in_new

Defines medical necessity and exclusions for manipulative therapy for musculoskeletal disorders, lists applicable procedure codes and related policies, provides definitions and evidence summaries for various conditions (back, neck, shoulder, scoliosis, extremities). Does not apply to specified states where separate state policies exist.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyManipulative Therapy – Community Plan Medical Policyopen_in_new

Policy CodePolicy CS076.P

Change TypeDefinitions removed; Description/Clinical Evidence/References revised

Effective DateJun 1, 2026

Next Review Date

Key ActionDocument clinical indication, prior conservative care and expected short-term goals when using manipulative/manual therapy for musculoskeletal conditions.

SourceLink

POLICY UPDATE CHANGES

Removed definition of 'Upledger Technique'.

Updated Description of Services, Clinical Evidence, and References sections to reflect most current information.

CoverageMusculoskeletal disorders covered; other indications excluded

mostly low-to-moderateQuality of evidence (general)

short-termTypical outcome timeframe

Procedure codes referenced

noneHigh-quality consistent positives

Coverage Summary & Scope

This policy covers manipulative therapy for Musculoskeletal Disorders as medically necessary — defined as injuries or conditions originating from joints, muscles, ligaments, discs, or other soft tissues in the spine or limbs producing clinically relevant symptoms and functional limitations. Other indications (nonmusculoskeletal disorders such as asthma, otitis media, infantile colic, internal organ/visceral disorders), preventive/maintenance/custodial care, craniosacral therapy (CST), temporomandibular joint disorder, scoliosis, and manipulative services using nonstandard techniques are considered unproven or not medically necessary. This policy lists applicable procedure codes (e.g., OMT and chiropractic codes) and references related policies (e.g., electrical stimulation, home traction, manipulation under anesthesia). Do not apply this Medical Policy to members in the listed states; refer to state-specific policy/guideline for Idaho, Indiana, Kansas, Kentucky, Nebraska, New Jersey, New Mexico, North Carolina, Ohio, Pennsylvania, and Tennessee.

Policy quick facts

Policy numberCS076.P

Effective dateJune 1, 2026

Coverage stanceMixed — musculoskeletal disorders covered; other indications generally unproven/not medically necessary

StatusCURRENT

Typical outcome timeframeShort-term benefits reported (most trials report short-term improvements)

State-specific exceptionsPolicy does not apply to listed states — Idaho, Indiana, Kansas, Kentucky, Nebraska, New Jersey, New Mexico, North Carolina, Ohio, Pennsylvania, Tennessee; refer to state-specific policy/guideline

Medical Necessity and Exclusions

Evidence Summary and Guideline Conclusions

Manipulative Therapy is defined as the therapeutic manual application of pressure or force in which the practitioner moves or manipulates one or more parts of the individual’s body to achieve and maintain health, and can include chiropractic, physical therapy, massage, OMT, and other manual techniques. The policy cross-references related policies — for example, Manipulation Under Anesthesia and other community plan policies such as Electrical Stimulation for Pain, Home Traction Therapy, Motorized Spinal Traction, and Treatment of Temporomandibular Joint Disorders. The policy emphasizes coverage and evidence for musculoskeletal disorders while identifying craniosacral therapy (CST) and other nonstandard techniques as unproven due to insufficient high-quality evidence and methodological concerns.

Selected evidence highlights

Opioid-sparing associationVHA cohort (Lisi et al. 2025): chiropractic care associated with lower 1-year opioid fills (13.2% vs 17.1%; adjusted HR 0.77; NNT ~26-27)

Infantile colic evidenceSome RCTs/meta-analyses show reduced crying hours (meta-analysis effect size −2.46; p<0.00001) but studies are small and biased

Craniosacral therapy (CST) meta-analysesAmendolara et al. (2024): 24 RCTs (n=1,613) — no significant effects overall; subgroup signals limited by bias and wide prediction intervals

Definitions

Definitions provided in the policy include:

- Manipulative Therapy: therapeutic manual pressure or force where the practitioner moves or manipulates body parts to achieve and maintain health; includes chiropractic, physical therapy, massage, and OMT.

- Musculoskeletal Disorders: injuries or conditions originating from joints, muscles, ligaments, discs, or other soft tissues in the spine or limbs that produce clinically relevant symptoms (e.g., pain, numbness) and functional limitations.

- OMT (Osteopathic Manipulative Treatment): hands-on techniques performed by osteopathic practitioners targeting somatic dysfunction; evidence for nonmusculoskeletal indications is mixed and limited.

- SMT (Spinal/Spinal Manipulative Therapy): spinal manipulation/mobilization techniques used in treatment of musculoskeletal conditions.

- MC (Maintenance Care): preventive manipulative treatment intended for maintenance rather than restoration; considered insufficiently supported for routine coverage.

- Craniosacral therapy (CST): a low-force manual technique aiming to manipulate cranial and sacral rhythms; considered unproven per this policy due to insufficient evidence.

- Manipulative therapy (umbrella): manual/spinal manipulation, mobilization, craniosacral therapy, OMT and related manual techniques used to treat musculoskeletal (and some nonmusculoskeletal) conditions.

Procedure and HCPCS Codes

Included/Referenced Procedure CodesCPT

98925	Osteopathic manipulative treatment (OMT); 1-2 body regions involved
98926	OMT; 3-4 body regions involved
98927	OMT; 5-6 body regions involved
98928	OMT; 7-8 body regions involved
98929	OMT; 9-10 body regions involved
98940	Chiropractic manipulative treatment (CMT); spinal, 1-2 regions
98941	CMT; spinal, 3-4 regions
98942	CMT; spinal, 5 regions
98943	CMT; extraspinal, 1 or more regions

HCPCS / Maintenance CodeHCPCS

S8990

Physical or manipulative therapy performed for maintenance rather than restoration

Coding clarification: For guidance regarding CPT code 97140 (manual therapy techniques, one or more regions, each 15 minutes), providers should refer to the Medical Policy titled Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech). This policy advises consulting that Habilitation and Rehabilitation Therapy policy for billing relation of 97140.

Provider Impact & Required Actions

Documentation Required

State Policy Applicability

Do not apply this Medical Policy for members in the listed states; refer to the state-specific policy/guideline as noted.

Idaho
Indiana
Kansas
Kentucky
Nebraska
New Jersey
New Mexico
North Carolina
Ohio
Pennsylvania
Tennessee

Detailed Evidence Highlights

Evidence table (selected items)

Opioid-sparing associationLisi et al. (2025) VHA study: chiropractic care users had lower 1-year opioid prescription fills (13.2% vs 17.1%); adjusted HR 0.77; NNT ≈26-27

Infantile colic RCTsBuffone et al. (2022) meta-analysis and RCTs: two studies pooled for crying hours showed effect size −2.46 (p<0.00001); overall evidence limited by small sizes and bias

Craniosacral therapy meta-analysesAmendolara et al. (2024): 24 RCTs (n=1,613) — no significant overall effects; subgroup signals (neonate health, chronic pain) tempered by high bias and wide prediction intervals; Ceballos-Laita (2024) found no benefits

AOA guidelinePopovich et al. (2024): rates OMT evidence for chronic low back pain as weak; recommends larger, low-bias RCTs

IFOMPT/IOPTP positionGross et al. (2024): position statement recommends against spinal manipulation/mobilisation in infants and for many pediatric nonmusculoskeletal conditions

Policy Revision History

06/01/2026removed

Removed definition of 'Upledger Technique' from Definitions section.

06/01/2026revisedLatest

Supporting Information updated: Description of Services, Clinical Evidence, and References sections revised to reflect most current information; previous policy version CS076.O archived.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyManipulative Therapy – Community Plan Medical Policyopen_in_new

Policy CodePolicy CS076.P

Change TypeDefinitions removed; Description/Clinical Evidence/References revised

Effective DateJun 1, 2026

Next Review Date

Key ActionDocument clinical indication, prior conservative care and expected short-term goals when using manipulative/manual therapy for musculoskeletal conditions.

SourceLink

On This Page

AOA guidelineAOA (Popovich et al., 2024): evidence for OMT in chronic LBP considered weak; recommends larger low-bias RCTs

IFOMPT/IOPTP positionGross et al. (2024): do NOT recommend spinal manipulation/mobilisation for infants/children for nonmusculoskeletal pediatric conditions (e.g., colic, asthma)

Documentation Required

Coding Clarification

Refer to the Medical Policy titled Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) for guidance regarding CPT code 97140 (manual therapy techniques, one or more regions, each 15 minutes).

97140

Documentation Required

Evidence-based indication documentation

Document the clinical indication, prior conservative care, expected short-term goals, known limitations of the evidence, and follow-up plans when using manipulative/manual therapy for musculoskeletal conditions.

Clinical indication
Prior conservative care
Expected short-term goals
Limitations of evidence
Follow-up plans

Denial Risk

Preventive maintenance/chronic custodial care

Preventive, maintenance, or custodial manipulative treatment lacks sufficient evidence of effectiveness; claims for routine preventive/maintenance manipulative therapy may be denied or subject to medical necessity review.

Documentation Required

Evidence-based limitation to nonmusculoskeletal indications

Evidence for manipulative therapies for nonmusculoskeletal indications is limited and inconclusive; when treating nonmusculoskeletal conditions, document the clinical rationale, limited supporting evidence, and that informed consent was obtained discussing uncertain benefit and limited safety data.

Prior Authorization

Prior authorization implication (policy-level)

Prior authorization and coverage decisions may restrict payment for manipulative therapies used to treat nonmusculoskeletal conditions unless documented medical necessity and supporting evidence are provided.

Documentation Required

Use policy as interpretive guidance

Refer to federal, state, or contractual benefit plan terms when deciding coverage; contractual terms govern in event of conflict. Use this policy to assist interpretation of UnitedHealthcare standard benefit plans.

Documentation Required

Consider external tools

UnitedHealthcare may use third-party tools (e.g., InterQual®) to assist in administering benefits; be prepared to supply documentation consistent with those tools if requested.

Safety note: across systematic reviews and trials the policy reports no consistent serious adverse events were reported, but adverse-event surveillance and reporting were frequently inadequate; therefore safety conclusions are limited and clinicians should counsel patients accordingly.