Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerPolicy UpdatesPhysical Medicine, Rehab & Therapiesmediviewcurative Chiropractic Coverage Update | Op…
    Ask Trek AI about this page
    CurrentmediviewcurativePolicy MM-PNP-010

    Chiropractic Services Policy

    Customize your policy alerts

    Sign up for mediviewcurative Policy MM-PNP-010 alerts

    Get alerted when Policy MM-PNP-010 changes without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Policy governing coverage and medical necessity criteria for chiropractic services for Curative Health Plan PPO+ members; applies to Medical Utilization Management staff and providers requesting coverage.

    Policy Summary
    Payermediviewcurative
    PolicyChiropractic Services Policy
    Policy CodePolicy MM-PNP-010
    Change TypeNo material changes
    Effective DateOct 1, 2023
    Next Review Date
    Key ActionDocument neuromusculoskeletal diagnosis and objective improvement within 2 weeks; if no improvement, modify treatment before approving additional care.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    PPO+Membership segment covered
    2 wksInitial improvement required
    30 daysPost-modification window
    AllowedHome-based allowed
    Many listed

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Experimental procedures

    Coverage and Medical Necessity Criteria

    Medical Necessity — Covered when ALL of the following are met:

    Covered when ALL of the following are met:

    Medical necessity criteria: The member has a neuromusculoskeletal disorder; and the medical necessity for treatment is clearly documented; and improvement is documented within the initial 2 weeks of chiropractic care.improvement documented within 2 weeks

    If no improvement within the initial 2 weeks, additional chiropractic treatment is not medically necessary unless the chiropractic treatment is modified; if no improvement within 30 days despite modification, continued chiropractic treatment is not medically necessary; once maximum therapeutic benefit has been achieved, continuing care is not medically necessary; home-based chiropractic service may be considered when member is homebound.

    Not medically necessary / Limits

    Not medically necessary / Limits: Chiropractic manipulation in asymptomatic persons or in persons without an identifiable clinical condition; chiropractic care in persons whose condition is neither regressing nor improving; continued care after maximum therapeutic benefit has been achieved.

    Chiropractic manipulation has no proven value for idiopathic scoliosis or for treatment of scoliosis beyond early adolescence unless the member has pain, spasm, or other medically necessary indications.

    Manipulation delivered for conditions that are not neuromusculoskeletal is considered experimental/investigational and is excluded. Examples include treatment of attention-deficit hyperactivity disorder, asthma, autism spectrum disorder, depression, dizziness/vertigo, dysmenorrhea, epilepsy, female infertility, gastrointestinal disorders, improvement of brain function, menopause-associated vasomotor symptoms, prevention of falls, and post-concussion syndrome. Manipulation of infants for non-neuromusculoskeletal indications (for example, infant gastrointestinal disorders, excessive intestinal gas, and gastroesophageal reflux disease) is likewise considered experimental/investigational and excluded.

    The policy identifies a list of named chiropractic techniques, procedures, devices, and diagnostic tests as experimental/investigational and not supported. Chiropractic procedures and techniques listed include, but are not limited to: Active Release Technique; Active Therapeutic Movement (ATM2); Advanced Biostructural Correction (ABC) Chiropractic Technique; Atlas Orthogonal Technique; Cox decompression manipulation; Cranial Manipulation; Manipulation Under Anesthesia; NUCCA procedure; Spinal Adjusting Devices (e.g., Activator, ProAdjuster, PulStarFRAS, Ultralign); Upledger/Cranio‑Sacral Therapy; Webster Technique (for breech babies); and many others enumerated in the procedure list. Diagnostic procedures identified as experimental/investigational include computerized radiographic mensuration analysis; dynamic spinal visualization (digital motion x‑ray / videofluoroscopy / cineradiography); Neurocalometer/Nervoscope; para‑spinal or surface EMG; spinoscopy; and thermography.

    Additional chiropractic treatment beyond the initial course is considered not medically necessary if there is no documented improvement within the initial 2 weeks of care unless the chiropractic treatment is modified. If no improvement is documented within 30 days after modification of treatment, continued chiropractic treatment is considered not medically necessary. Once the maximum therapeutic benefit has been achieved, continuing care is not medically necessary.

    The policy states that chiropractic manipulation has no proven value for the treatment of idiopathic scoliosis or for treatment of scoliosis beyond early adolescence, except when the member is exhibiting pain or spasm or when other medically necessary indications for manipulation are present.

    Coding and Procedural Lists

    Chiropractic procedures listedmixedExperimental
    Active Release TechniqueListed chiropractic procedure considered under policy review
    Active Therapeutic Movement (ATM2)Listed chiropractic procedure considered under policy review
    Advanced Biostructural Correction (ABC) Chiropractic TechniqueListed chiropractic procedure considered under policy review
    Applied Spinal Biomechanical EngineeringListed chiropractic procedure considered under policy review
    Atlas Orthogonal TechniqueListed chiropractic procedure considered under policy review
    Bioenergetic Synchronization TechniqueListed chiropractic procedure considered under policy review
    Biogeometric IntegrationListed chiropractic procedure considered under policy review
    Blair TechniqueListed chiropractic procedure considered under policy review
    Bowen TechniqueListed chiropractic procedure considered under policy review
    Chiropractic Biophysics Technique / Chiropractic BioPhysics MethodsListed chiropractic procedure considered under policy review
    1–10 of 36
    1/4
    Diagnostic procedures listedmixedExperimental
    Computerized radiographic mensuration analysisDiagnostic procedure listed
    Dynamic spinal visualization / digital motion x-ray / videofluoroscopy / cineradiographyDiagnostic procedure listed
    Neurocalometer/NervoscopeDiagnostic procedure listed
    Para-spinal electromyography (EMG) / Surface scanning EMGDiagnostic procedure listed
    SpinoscopyDiagnostic procedure listed
    ThermographyDiagnostic procedure listed
    inv-09: Initial improvement interval — improvement documented within 2 weeks
    Required intervalImprovement must be documented within the initial 2 weeks of chiropractic care.
    If no improvement — short-term actionIf no improvement is documented within the initial 2 weeks, additional chiropractic treatment is not medically necessary unless the chiropractic treatment is modified.
    Home-based exceptionHome-based chiropractic service may be considered medically necessary in selected cases when the member is homebound.
    inv-10: Post-modification interval — improvement documented within 30 days after treatment modification
    Post-modification intervalIf treatment is modified, improvement must be documented within 30 days after the modification.

    Provider Responsibilities and Authorization Guidance

    Prior Authorization

    Coverage applies to PPO+ members (follow Medical UM procedures)

    This policy applies only to PPO+ members and is administered by Medical Utilization Management. Providers must follow Medical UM procedures when requesting authorization for chiropractic services.

    Step Therapy

    Require documented improvement within 2 weeks; modify care if not improving

    Document objective improvement within the initial 2 weeks of chiropractic care; if no improvement is documented in that interval, the provider must modify the chiropractic treatment before additional care will be approved.

    • Improvement must be documented within the initial 2 weeks of care.
    • If no improvement in 2 weeks, treatment must be modified prior to approval of additional chiropractic treatment.

    Background

    Chiropractic services within this policy are intended to treat neuromusculoskeletal disorders. Medical necessity requires documentation of the neuromusculoskeletal diagnosis, a clear rationale for chiropractic treatment, and objective evidence of improvement within the initial 2 weeks of care (or after treatment modification if applicable). Home‑based chiropractic services may be considered medically necessary for selected, homebound members. Medical Utilization Management associates are responsible for understanding and enforcing the documentation and review procedures described in the policy.

    Definitions

    inv-18: Definitions — No definitions provided in the policy.
    Definitions providedNo definitions provided in the policy (3.1. N/A).
    Section referenceSee policy Definitions section: 3. DEFINITIONS — 3.1. N/A.
    Interpretation guidanceAbsent policy definitions, apply standard clinical interpretation and Medical UM documentation standards when evaluating requests.
    Policy Summary
    Payermediviewcurative
    PolicyChiropractic Services Policy
    Policy CodePolicy MM-PNP-010
    Change TypeNo material changes
    Effective DateOct 1, 2023
    Next Review Date
    Key ActionDocument neuromusculoskeletal diagnosis and objective improvement within 2 weeks; if no improvement, modify treatment before approving additional care.
    SourceLink
    On This Page
    Coverage and Medical Necessity CriteriaCoding and Procedural ListsProvider Responsibilities and Authorization GuidanceBackgroundDefinitions
    If still no improvement
    If no improvement is documented within 30 days despite modification of chiropractic treatment, continued chiropractic treatment is considered not medically necessary.
    Relation to initial intervalThis 30-day post-modification interval applies only when initial 2-week improvement is not documented and treatment has been modified.
    Documentation Required

    Document diagnosis, medical necessity, and objective improvement

    Document the member's neuromusculoskeletal diagnosis, medical necessity for chiropractic treatment, and objective evidence of improvement within the initial 2-week interval (or after treatment modification if applicable).

    • Record the neuromusculoskeletal diagnosis.
    • Document clear medical necessity for the treatment provided.
    • Document objective evidence of improvement within the initial 2 weeks (or within 30 days after treatment modification).
    Note

    Medical UM associates: read procedure and follow documentation guidance

    Medical UM associates are responsible for reading and comprehending this procedure and following the policy's documentation expectations; the policy references 'N/A' for some documentation standards but staff must contact management or Privacy and Compliance with questions.

    • All Medical UM associates must read and comprehend this procedure.
    • Contact management or Privacy and Compliance with any questions regarding documentation standards noted as N/A.
    Denial Risk

    Lack of improvement within initial 2 weeks may make care not medically necessary

    If no improvement is documented within the initial 2 weeks of chiropractic care, additional chiropractic treatment is considered not medically necessary unless the treatment is modified; if no improvement is documented within 30 days despite modification, continued chiropractic treatment is considered not medically necessary.

    • No documented improvement in 2 weeks → additional treatment not medically necessary unless treatment is modified.
    • No documented improvement within 30 days after modification → continued treatment not medically necessary.
    Denial Risk

    Avoid manipulation for asymptomatic persons, non-neuromusculoskeletal, or infant non‑neuromusculoskeletal indications

    Do not provide chiropractic manipulation for asymptomatic persons, for non-neuromusculoskeletal conditions, or for infants for non-neuromusculoskeletal indications; such uses are considered not medically necessary or experimental and may be denied.

    • Manipulation in asymptomatic persons or without an identifiable clinical condition is not medically necessary.
    • Manipulation for non-neuromusculoskeletal conditions (examples listed in policy) is excluded.
    • Manipulation of infants for non-neuromusculoskeletal indications (examples listed in policy) is excluded.