CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Complementary and Alternative Medicine (CAM) payment policy

Governs reimbursement and coverage rules for complementary and alternative medicine services (chiropractic and acupuncture) for Neighborhood Health Plan of Rhode Island members across Medicaid (excluding EFP), QINTEGRITY, and Commercial lines.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyComplementary and Alternative Medicine (CAM) payment policy

Policy CodePolicy N/A

Change TypeMinor or no material changes

Effective DateN/A

Next Review DateN/A

Key ActionProviders must verify member eligibility, coverage and authorization criteria and contact Provider Services for questions.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

12chiropractic visit limit (rolling)

12acupuncture visit limit (annual)

4diagnoses for covered acupuncture

Excludedmassage therapy coverage status

97810-97814approved acupuncture CPT codes listed

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Coverage Rules for CAM Services

CAM coverage rules

Covered services, limits, and coding requirements

CAM services covered include chiropractic and acupuncture services as listed below.

Chiropractic Services

Coverage: Chiropractic services are covered with limits.
Visit limit: Limited to 12 visits per year (rolling).
Units per day: Only 1 unit of listed Chiropractic Manipulative Treatment (CMT) codes (98940-98942) allowed per day.
Diagnostics: If a chiropractor orders, takes, or interprets X-rays or other diagnostic procedures to demonstrate subluxation, those services may be used for documentation but are not covered or payable when ordered or furnished by the chiropractor.

Acupuncture Services

Coverage: Acupuncture services are covered with limits and only for specified diagnoses.
Visit limit: Limited to 12 visits per year.
Allowed diagnoses: Covered only for chronic low back pain, fibromyalgia, and chronic migraine (and other listed diagnoses where applicable).
Approved CPT codes: 97810, 97811, 97813, 97814.

Excluded Services

Massage therapy services are excluded from coverage.

Billing and Coding Requirements

Claims must be submitted using applicable CPT (e.g., 97810-97814 for acupuncture; 98940-98942 for CMT), ICD-10-CM, and HCPCS coding standards and within contractual timely filing guidelines.
Payments are subject to member eligibility, contract rules, claim edits, and any required authorizations.

Additional Chiropractor Codes (Physiotherapy licensed)

Chiropractors who also hold a physiotherapy license may bill additional modality/physiotherapy codes where applicable (see coding tables).

Approved Codes and Billing Parameters

Approved acupuncture and chiropractic CPT codesCPTCovered

97810	Acupuncture, 1 or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient.
97811	Acupuncture; 1 or more needles; without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure).
97813	Acupuncture, 1 or more needles; with electrical stimulation; initial 15 minutes of personal one-on-one contact with the patient.
97814	Acupuncture, 1 or more needles; with electrical stimulation; each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure).
98940	Chiropractic manipulative treatment (CMT); spinal, 1-2 regions.
98941	Chiropractic manipulative treatment (CMT); spinal, 3-4 regions.
98942	Chiropractic manipulative treatment (CMT); spinal,5 regions

Additional modalities and physiotherapy codes (where applicable)CPTCovered

97010	Application of a modality to 1 or more areas; hot or cold packs.
97110	Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility.
97124	Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage_petrissage and/or tapotement (stroking_compression,_percussion).
G0283	Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a plan of care therapy.
S8948	Application of a modality (requiring constant provider attendance) to one Or more areas; low-level laser; each 15 minutes.

Chiropractic units per day

Chiropractic units per day1 unit of listed chiropractic manipulative treatment (CMT) codes (98940-98942) allowed per day

Applicable codes98940, 98941, 98942 (CMT spinal regions)

Billing noteOnly one unit of any listed CMT code may be billed per day; additional diagnostic services ordered by chiropractors (e.g., X-ray) are not covered for payment

Visit limits

Chiropractic visit limit12 visits per year (rolling)

Acupuncture visit limit12 visits per year

Provider Responsibilities and Authorization

Prior Authorization

Verify eligibility, coverage, and authorizations before services

It is the provider’s responsibility to verify member eligibility, coverage, and any prior authorization requirements before rendering services. Refer to Neighborhood’s Prior Authorization Reference page and Clinical Medical Policies for details and contact Provider Services at 1-800-963-1001 with questions.

Policy Terms and Definitions

Complementary and Alternative Medicine (CAM)

DefinitionComplementary and Alternative Medicine (CAM) is defined as non-conventional services that are used together with or in place of conventional medical care

ScopeIncludes services such as chiropractic and acupuncture when used as alternatives or adjuncts to conventional care

Policy contextProvides payment guidance and limits for CAM services under the plan