RetiredUnitedHealthcarePolicy CS076LA.M

Manipulative Therapy La Cs

State-specific UnitedHealthcare Community Plan medical policy for manipulative therapy (Louisiana only) describing coverage for chiropractic and osteopathic manipulative services, definitions, applicable CPT/CPT-adjacent codes (reference), covered indications (musculoskeletal disorders), exclusions (non-musculoskeletal and specified techniques), and supporting evidence summaries.

Policy Summary

PayerUnitedHealthcare

PolicyManipulative Therapy La Cs

Policy CodePolicy CS076LA.M

Change TypeRetirement; state-specific coverage and documentation updates

Effective DateSep 1, 2025

Next Review Date

Key ActionProviders must document a treatment plan at the initial visit including level of care, treatment goals, and measures to assess effectiveness, and document progress at follow-up visits.

SourceLink

POLICY UPDATE CHANGES

Policy marked as Retired April 1, 2026; Effective Date range Sept 1, 2025 - March 31, 2026 included in header.

Added state-specific criteria clarifying coverage for chiropractic services for under-21 enrollees requiring EPSDT referral and for adults age 21+ with documentation requirements for treatment plans and follow-up.

Modified non state-specific language to specify 'osteopathic Manipulative Therapy' as proven and medically necessary for treating Musculoskeletal Disorders, except as noted.

Policy retired for Louisiana plan membership with disenrollment effective 04/01/2026.

Supporting Information: Updated Clinical Evidence and References sections to reflect current information.

Archived previous policy version CS076LA.L.

1State-specific policy (Louisiana)

MSDCovered Indication Type

LowOverall evidence quality

RetiredPolicy Status (LA)

Coverage Summary

State-specific UnitedHealthcare Community Plan policy for Louisiana. Coverage stance: mixed — osteopathic manipulative therapy (OMT) and chiropractic spinal manipulation are covered for musculoskeletal disorders (MSDs), while manipulative therapy for non-MSD indications and several specified techniques is not medically necessary / unproven. Scope: applies only to Louisiana enrollees and describes coverage rules by age group, definitions, applicable codes, covered MSD indications and listed exclusions for non-MSD uses and nonstandard techniques. Policy status: RETIRED effective 2026-04-01. Effective date range shown in header: 2025-09-01 to 2026-03-31.

Surface key metadata

Policy numberCS076LA.M

Effective date2025-09-01

Retirement date2026-04-01

StatusRETIRED

Scope summaryState-specific UnitedHealthcare Community Plan medical policy for manipulative therapy (Louisiana only) describing coverage for chiropractic and osteopathic manipulative services, definitions, applicable CPT/CPT-adjacent codes, covered indications (musculoskeletal disorders), exclusions (non-musculoskeletal and specified techniques), and supporting evidence summaries.

State applicabilityLouisiana

Medical-Necessity Criteria

Application

This Medical Policy only applies to the state of Louisiana.

Policy applies only to enrollees in Louisiana; state-specific mandates and fee-schedule determinations govern coverage and reimbursement for manipulative therapy services rendered to Louisiana members.

Chiropractic Services for Under 21 Years of Age

Covered when ALL of the following are met:

ALL of the following

Member is under 21 years of age.
Services are chiropractic manipulative treatment (CMT) or osteopathic manipulative treatment (OMT).

Evidence Summaries and Rationale

Evidence-based conclusions by condition

Coverage-relevant conclusions summarized from clinical trials and systematic reviews by condition:

Carpal Tunnel Syndrome: OMT resulted in participant-perceived improvement in symptoms and function for CTS but without changes in median nerve function or morphology; study limited by unknown population and short follow-up.

Hip Osteoarthritis / Parkinson's gait: Single-session OMT-WB increased total sagittal hip ROM in Parkinson's disease (p = 0.038); waveform analyses showed no pointwise gait differences; systematic reviews indicate exercise superior for hip OA and low-quality evidence suggests manual therapy may offer short-term pain benefit.

Knee Osteoarthritis: Systematic reviews and RCTs show manual/OMT plus exercise may improve pain and function short-term after TKA or for knee OA; studies are small/heterogeneous and confirmatory trials needed.

State-Specific Coverage Rationale (Louisiana)

State-Specific Coverage Rationale (summary of changes 09/01/2025)

Added language describing coverage for chiropractic services by age and documentation requirements (summary of changes effective 09/01/2025):

Under-21 EPSDT requirement: Chiropractic manipulative treatment for enrollees under 21 years of age is covered when medically necessary and upon referral from an EPSDT medical screening primary care provider.

Adults 21+ coverage and documentation: Chiropractic services for adults age 21 and older are covered and considered medically necessary for diagnosing and treating neuromusculoskeletal conditions associated with the functional integrity of the spine.

Chiropractic spinal manipulation specifics: Chiropractic spinal manipulation of up to five regions is covered and considered medically necessary when included in the documented treatment plan. The initial visit must include a treatment plan documenting level of care (duration and frequency of visits), treatment goals, and measures to assess effectiveness (qualitative and/or quantitative). Follow-up visits must document the enrollee's progress and the measures used to assess effectiveness.

Relevant Procedure Codes

Reference Procedure Codes (may not be all inclusive)CPT

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
S8990	Physical or manipulative therapy performed for maintenance rather than restoration

Provider Actions & Documentation Requirements

Documentation Required

Initial visit treatment plan required

The initial chiropractic visit must include a documented treatment plan. The plan should state the intended level of care (expected duration and frequency of visits), clear treatment goals, and the measures (qualitative and/or quantitative) that will be used to assess treatment effectiveness.

Required elements: level of care (duration and frequency of visits)
Required elements: specific treatment goals
Required elements: measures to assess effectiveness (e.g., pain scores, functional status, objective findings)

Documentation Required

Follow-up visit documentation required

Follow-up visits must document the enrollee's progress toward the treatment goals and include the measures used to assess effectiveness. Documentation should show response to therapy and any changes to the treatment plan.

Definitions

Definitions (concise):

• Manipulative Therapy: therapeutic manual application of pressure or force to move or manipulate body parts (includes OMT/OMM, manual therapy, chiropractic and physical therapy methods) used to treat structural and functional issues in bones, joints, tissues, and muscles.

• Musculoskeletal Disorders (MSDs): 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.

• Upledger Technique: a complementary light‑touch craniosacral treatment developed by John E. Upledger intended to work with the craniosacral system to support the central nervous system.

• OMT (Osteopathic Manipulative Treatment): hands-on manual therapy by osteopathic practitioners for diagnosis and treatment of somatic dysfunction.

• SMT (Spinal Manipulative Therapy): spinal manipulation including high‑velocity low‑amplitude thrusts and mobilization techniques.

• MC (Maintenance Care): ongoing preventive or scheduled manipulative therapy after an initial therapeutic response.

• Craniosacral therapy (CST): light‑touch cranial/manual technique aimed at craniosacral rhythms; considered unproven due to limited/low‑quality evidence.

• OVM (Visceral Osteopathic Manipulation): manual techniques directed at improving mobility and function of internal organs and surrounding tissues.

Revision History

2026-04-01retirementLatest

Policy retired for Louisiana plan membership; disenrollment effective April 1, 2026. (Document title: 'Retired April 1, 2026')

2025-09-01 to 2026-03-31effective_date_range

Policy effective date range in header: September 1, 2025 - March 31, 2026.

2025-09-01coverage_language_change

State-specific criteria added clarifying chiropractic coverage: under-21 chiropractic manipulative treatment covered when medically necessary with EPSDT referral; adults 21+ covered for diagnosing/treating neuromusculoskeletal spine conditions with chiropractic spinal manipulation of up to five regions covered when included in the documented treatment plan, and initial/follow-up visit documentation requirements (level of care, treatment goals, measures to assess effectiveness).

Policy Summary

PayerUnitedHealthcare

PolicyManipulative Therapy La Cs

Policy CodePolicy CS076LA.M

Change TypeRetirement; state-specific coverage and documentation updates

Effective DateSep 1, 2025

Next Review Date

Key ActionProviders must document a treatment plan at the initial visit including level of care, treatment goals, and measures to assess effectiveness, and document progress at follow-up visits.

SourceLink

On This Page

Referral/authorization: there is a documented referral from an EPSDT medical screening primary care provider as required by Louisiana EPSDT program rules.

Services are medically necessary for diagnosis or treatment of a musculoskeletal disorder (MSD) or related functional limitation as described in policy definitions.

Documentation supports the need for manipulative treatment and the expected functional benefit; the EPSDT referral must be retained in the medical record.

Chiropractic Services for Adults Age 21 and Older

Covered when ALL of the following are met:

ALL of the following

Member is age 21 years or older.
Service is provided for the diagnosis or treatment of neuromusculoskeletal conditions associated with the functional integrity of the spine (musculoskeletal disorders as defined in the policy).
Chiropractic spinal manipulation is limited to up to five spinal regions when included in the documented treatment plan.
Initial visit documentation includes a written treatment plan that specifies: level of care (anticipated duration and frequency of visits); treatment goals; and measures to assess effectiveness (qualitative and/or quantitative).
Follow-up visits include documentation of the enrollee's progress toward treatment goals and the measures used to assess effectiveness.
Services not meeting the above criteria or lacking adequate documentation are subject to denial as not medically necessary.

Osteopathic Manipulative Services - Covered and Not Covered

Osteopathic manipulative therapy (OMT) is considered medically necessary for musculoskeletal disorders (MSDs). Manipulative therapy is considered not medically necessary or unproven for non-MSD indications and certain specific techniques as listed below.

Covered (for MSDs)

Osteopathic manipulative therapy (OMT) and chiropractic manipulative treatment (CMT) when used to diagnose or treat musculoskeletal disorders (MSDs) affecting joints, muscles, ligaments, discs, or other soft tissues of the spine or limbs that produce clinically relevant symptoms and functional limitations.
OMT/CMT must be documented in a treatment plan with goals and measures of effectiveness as required under the policy.

Not medically necessary / Unproven

Non-musculoskeletal disorders (examples: asthma, otitis media, infantile colic, internal organ disorders).
Prevention, maintenance, or custodial care without expectation of functional improvement or restoration of health.
Craniosacral therapy (cranial manipulation/Upledger Technique).
Temporomandibular joint (TMJ) disorder (manipulative therapy for TMJ is listed as unproven in this policy).
Scoliosis (manipulative therapy as a primary therapy for scoliosis is considered unproven).
Manipulative services that utilize nonstandard techniques (examples: applied kinesiology including the neural organizational technique; National Upper Cervical Chiropractic Association (NUCCA) technique).
Any other indications lacking sufficient evidence of efficacy; these are considered unproven or not medically necessary.

Evidence-based conclusions and applicability

Evidence-based conclusions and applicability:

Systematic reviews and meta-analyses show promising but limited evidence supporting OMT/MT for certain musculoskeletal conditions (e.g., acute and chronic non-specific low back pain, some neck pain) but overall primary study quality and heterogeneity limit definitive conclusions; therefore coverage is limited to MSD indications with documentation requirements as specified above.

This policy reflects Louisiana-specific applicability and reimbursement determinations; codes not on the State of Louisiana Medicaid Fee Schedule are noted in the Applicable Codes section and are not covered by the State program.

Non State-Specific Coverage Rationale (summary of changes 09/01/2025)

Non State-Specific Coverage Rationale (summary of changes 09/01/2025):

Effective 09/01/2025 the policy clarifies documentation requirements: initial visit must include a treatment plan with level of care, goals, and measures of effectiveness; follow-up visits must document progress using stated measures.

Policy reaffirms coverage of OMT/CMT for musculoskeletal disorders and specifies that chiropractic spinal manipulation is limited to up to five spinal regions when included in the documented treatment plan.

Policy clarifies and consolidates examples of indications considered unproven or not medically necessary (non-MSD conditions, maintenance care, craniosacral therapy/Upledger, TMJ, scoliosis, and nonstandard techniques such as applied kinesiology and NUCCA).

Codes not listed on the Louisiana Medicaid Fee Schedule remain non-covered by the State program; see Applicable Codes for code-level details.

Ankle & Foot: RCTs suggest manual therapy plus exercise improves pain, function, strength, and ROM for recurrent ankle sprains and plantar heel pain versus comparators; larger longer studies needed.

Headache (cervicogenic, migraine, tension-type): Systematic reviews/meta-analyses indicate spinal manipulation/mobilization may reduce cervicogenic headache and migraine days/pain in some trials; evidence quality variable with heterogeneity and risk of bias; mobilization effective when combined with exercise for chronic neck pain.

Temporomandibular Disorders (TMD): Evidence is mixed and insufficient; some small RCTs and reviews show short-term benefit of manual therapy or combined interventions but long-term efficacy and safety remain unproven.

Preventive / Maintenance Manipulative Treatment: Evidence insufficient to support preventive/maintenance use broadly; some trials show subgroup or small benefits for maintenance care but methodological limitations exist.

Non-musculoskeletal indications: Long-term safety and effectiveness not demonstrated for non-MSD indications (e.g., asthma, otitis media, infantile colic, immune outcomes); systematic reviews of acceptable-quality RCTs found SMT not superior to sham for several non-MSD conditions.

Evidence-based conclusions note limited applicability of manipulative therapies outside MSDs and for pediatrics. High-quality RCT syntheses (Global Summit and similar reviews) found no consistent benefit of SMT/OMT for non-musculoskeletal disorders and conclude evidence is insufficient to support treatment or prevention for conditions such as infantile colic, asthma, otitis media, hypertension, primary dysmenorrhea, and others. For pediatric populations the literature is heterogeneous: some small RCTs and systematic reviews report short-term positive effects for select conditions (e.g., infantile colic), but overall studies are low quality, at high risk of bias, and not generalizable. Craniosacral and other nonstandard techniques similarly have poor-quality or mixed evidence and cannot be recommended for non-MSD pediatric indications. Professional guidance restricts pediatric manipulation to specific musculoskeletal complaints and advises against manipulation for non‑musculoskeletal pediatric conditions.

Manipulative therapy (OMT/SMT/CMT) refers to manual techniques applied to bones, joints, tissues, and muscles to diagnose, treat, and prevent structural and functional problems. The policy differentiates that osteopathic Manipulative Therapy is proven and medically necessary for treating musculoskeletal disorders, whereas use of manipulative therapy for non-musculoskeletal indications and for certain nonstandard techniques (e.g., applied kinesiology, NUCCA), craniosacral therapy, visceral manipulation, maintenance/preventive care, and some TMJ or scoliosis applications is considered unproven or not medically necessary due to insufficient evidence.

Key cited evidence

Bagagiolo 2022 (overview SR/MA)Overview of 9 SRs/MAs and 55 trials suggesting promising but limited/low-quality evidence for OMT in musculoskeletal disorders

Nguyen 2021 (RCT)Standard OMT slightly better than sham for nonspecific subacute and chronic low back pain

Rubinstein 2019 / AHRQ (reviews)SMT similar to recommended therapies for chronic LBP with low-quality evidence for some outcomes; adverse events generally mild/transient

Dunning 2024 (RCT)Dry needling + upper cervical spinal manipulation superior to comparator for TMD at 3 months (n=120); study limitations noted

Eklund maintenance care (2018/2019 RCTs)Maintenance care reduced total days with bothersome LBP in select dysfunctional subgroup but overall mixed results and limitations

Chow 2021 (immune review)SMT associated with immediate biomarker changes but clinical significance/duration unknown; evidence neither supports nor refutes immune effects

Amendolara 2024 (CST meta-analysis)24 RCTs (1,613 participants): no significant effects overall; subgroup signals limited by bias and wide prediction intervals

Summary of non state-specific changes (09/01/2025): terminology was clarified to specify 'osteopathic Manipulative Therapy' as the proven, medically necessary modality for treating musculoskeletal disorders, with explicit exceptions noted for unproven or not medically necessary uses; scope language was clarified rather than broad generic wording of 'Manipulative Therapy.'

Include progress notes referencing initial treatment goals and objective/subjective measures used to evaluate response
Document any modifications to frequency, duration, or therapeutic approach

Prior Authorization

EPSDT referral requirement for under-21

For enrollees under 21 years of age, chiropractic manipulative treatment requires referral from an EPSDT medical screening primary care provider per state requirements. Ensure an EPSDT referral is on file before billing or delivering services.

EPSDT referral required for enrollees <21 years
Confirm referral source and include referral documentation in the patient record

Documentation Required

Evidence limitations and need for documentation

Evidence limitations: Manipulative therapy is supported for musculoskeletal disorders but is unproven for many non‑MSD indications. Document the clinical indication, objective findings, and prior conservative therapies tried and their outcomes. For maintenance care, prior authorization may be required or services may be considered non‑covered; document rationale for ongoing/maintenance treatment and objective benefit.

Document indication and objective findings supporting medical necessity
Document prior conservative therapies (e.g., medications, physical therapy, activity modification) and response
For maintenance care: document functional improvements and justification for continued treatment; check prior authorization requirements

Prior Authorization

Prior authorization considerations for maintenance care

Prior authorization considerations: Maintenance or preventive care (including S8990/maintenance CPTs where applicable) may be non‑covered or require prior authorization. Prior authorization should be obtained when continuation of care is beyond the initial restorative course or when treatment is primarily maintenance in intent.

Obtain prior authorization for continuation beyond demonstrated restorative benefit or when billed as maintenance
Codes to review with plan for authorization: S8990 (maintenance) and other non‑restorative service codes

Documentation Required

Evidence-based documentation expectations

Evidence‑based documentation expectations: Records should include a working diagnosis, objective exam findings, documented functional limitations, treatment goals, measures to assess change, and progress notes that demonstrate improvement (or rationale if therapy is discontinued). Lack of adequate documentation may result in denial.

Working diagnosis and relevant objective findings
Baseline functional assessment and follow-up measures (e.g., pain scales, functional questionnaires)
Progress notes tied to treatment goals showing improvement or justification for continued care

Denial Risk

Potential denials and prior authorization risk for non‑covered/experimental uses

Non‑covered or experimental uses (e.g., craniosacral therapy, NUCCA, applied kinesiology, pediatric non‑MSD indications) may be denied or require prior authorization. Confirm coverage with the member's plan, document the clinical rationale when using nonstandard techniques, and obtain prior authorization when indicated to reduce denial risk.

Craniosacral therapy and other nonstandard techniques are generally unproven and may be non‑covered
Pediatric non‑MSD indications typically require EPSDT referral and clinical justification
Confirm coverage and obtain prior authorization when in doubt

Note

Policy retirement effect

Policy retirement effect: This policy is retired for the period ending March 31, 2026. Providers must confirm current plan coverage and any changes to prior authorization or documentation requirements with the payer or applicable state Medicaid guidance.

Confirm current coverage policies and prior authorization requirements with UnitedHealthcare and state Medicaid before providing services
Policy retirement may change coding, covered indications, and administrative expectations

2025-09-01terminology_change

Non state-specific language revised to specify 'osteopathic Manipulative Therapy' as proven and medically necessary for treating Musculoskeletal Disorders (replacing more general 'Manipulative Therapy' wording).

2026-04-01operational_changeLatest

Operational removal for Louisiana plan: policy retired for Louisiana plan membership and previous policy version archived (CS076LA.L).