CurrentNeighborhood Health Plan of Rhode IslandPolicy #073

Acupuncture, Chiropractic, & In Lieu of Services

Defines coverage, clinical criteria, visit limits, prior authorization requirements, exclusions, and applicable lines of business for acupuncture, chiropractic, and in-lieu-of services for Neighborhood Health Plan of Rhode Island member lines (Medicaid, commercial, and certain duals) with stated exceptions.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyAcupuncture, Chiropractic, & In Lieu of Services

Policy CodePolicy #073

Change TypeReviewed / Revised (10/8/25)

Effective DateDec 10, 2019

Next Review Date

Key ActionAuthorization is required using the Neighborhood In Lieu Of Prior Authorization Request Form and providers must attest the service is used 'in lieu of' the described State Plan service.

SourceLink

POLICY UPDATE CHANGES

Policy reviewed and updated on 10/8/25 (last review date listed multiple times).

12Acupuncture visit limit (per year/calendar year)

12Chiropractic visit limit (per rolling year/plan year)

6Massage visits in lieu of meds/procedures (per rolling year)

3Primary LOB groups explicitly listed (MED, RHP, HBE, etc.)

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