CurrentUnitedHealthcarePolicy CSOZ6LAM

Manipulative Therapy (for Louisiana Only)

UnitedHealthcare Community Plan medical policy (Louisiana only) defining coverage and medical necessity criteria for chiropractic manipulative treatment and osteopathic manipulative therapy (OMT) for enrollees, including age-based state-specific criteria, definitions, applicable CPT/CPT-like codes, descriptions of services, and clinical evidence summaries.

Policy Summary

PayerUnitedHealthcare

PolicyManipulative Therapy (for Louisiana Only)

Policy CodePolicy CSOZ6LAM

Change TypeCoverage & criteria updates (age-based referral; adult treatment plan requirements; terminology)

Effective DateSep 1, 2025

Next Review Date

Key ActionAt the initial visit for adults 21 and older, document a treatment plan including level of care (duration/frequency), measures to assess effectiveness, and treatment goals.

POLICY UPDATE CHANGES

Added language indicating chiropractic manipulative treatment for enrollees under 21 is medically necessary when referred by an EPSDT primary care provider.

Replaced language to specify 'osteopathic Manipulative Therapy' is proven and medically necessary for treating Musculoskeletal Disorders, except where noted unproven/not medically necessary.

Added definition of 'Upledger Technique'.

Updated Clinical Evidence and References sections to reflect current information.

1State-specific policy (Louisiana only)

Up to 5

Allowed chiropractic spinal regions (adults)

Low–ModerateEvidence Quality

No proven benefitNon-musculoskeletal conclusions

CSOZ6LALPolicy version archived

Coverage Summary

This Louisiana-only UnitedHealthcare Community Plan policy (effective September 1, 2025) defines coverage and medical necessity for chiropractic manipulative treatment and osteopathic manipulative therapy (OMT/OMM/CMT) for enrollees, with age‑based state-specific criteria and referenced procedure codes. (Policy: CSOZ6LAM.)

For adults (age 21+), chiropractic services to diagnose and treat neuromusculoskeletal conditions of spinal functional integrity are covered when a documented treatment plan includes the required elements; chiropractic spinal manipulation is limited to up to five regions when included in the plan. For enrollees under 21, chiropractic manipulative treatment is covered when medically necessary and only upon referral from an EPSDT medical screening primary care provider.

Key facts

Policy numberCSOZ6LAM

State-specificLouisiana

Effective dateSeptember 1, 2025

Allowed spinal regions (adults)Up to 5 regions

Age-specific coverage categoriesUnder 21 (requires EPSDT referral); Age 21 and older (adult criteria)

Medical Necessity / Coverage Criteria

State-Specific Criteria: Chiropractic Services for Under 21 Years of Age

Chiropractic manipulative treatment is covered when ALL of the following are met:

ALL of the following

Enrollee is under 21 years of age
Service is medically necessary
Referral from an EPSDT medical screening primary care provider

Chiropractic Services for Adults Age 21 and Older (Initial and Follow-up Visit Requirements)

Chiropractic spinal manipulation (up to five regions) is covered and considered medically necessary when included in a documented treatment plan; coverage requires ALL of the following elements:

ALL of the following

Instructions, Nonstandard Techniques, and Exclusions

Instructions / Nonstandard Techniques Not Addressed or Excluded

The policy specifies techniques or indications that are not addressed or are excluded:

ANY of the following

Craniosacral therapy (cranial manipulation/Upledger Technique) — content mandated by Louisiana Department of Health (listed under Instructions for Use)
Scoliosis (manipulative therapy techniques for scoliosis are not considered proven/effective based on available evidence)
Temporomandibular joint (TMJ) disorder — listed in Instructions for Use as a topic
Manipulative services that utilize nonstandard techniques (e.g., applied kinesiology including neural organizational technique, NUCCA) — not addressed/considered nonstandard

CPT / Procedure Codes

Listed Procedure Codes (reference)CPT

98925	Osteopathic manipulative treatment (OMT); 1-2 body regions involved
98926	Osteopathic manipulative treatment (OMT); 3-4 body regions involved
98927	Osteopathic manipulative treatment (OMT); 5-6 body regions involved
98928	Osteopathic manipulative treatment (OMT); 7-8 body regions involved
98929	Osteopathic manipulative treatment (OMT); 9-10 body regions involved
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
98943	Chiropractic manipulative treatment (CMT); extraspinal, 1 region
S8990	Physical or manipulative therapy performed for maintenance rather than restoration

Provider Actions & Billing Rules

Documentation Required

Document and include treatment plan at initial visit (adults 21+)

The initial visit for adults (age 21 and older) must include documentation of a treatment plan. The treatment plan should be part of the medical record at the initial visit and support the medical necessity and scope of chiropractic spinal manipulation included in the plan.

Level of care (anticipated duration and frequency of visits)
Measures to assess the effectiveness of treatment (qualitative and/or quantitative outcome measures)
Treatment goals (specific, measurable objectives tied to expected functional improvement)

Documentation Required

Follow-up visit documentation requirement

Follow-up visits must document the enrollee's progress toward the treatment goals and the results of the measures used to assess treatment effectiveness. Progress notes should reference any changes to level of care, response to therapy, and plans for continuation, modification, or discontinuation of services.

Background and Evidence Summary

Manipulative therapies in this policy are defined to include osteopathic manipulative treatment (OMT/OMM), chiropractic manipulative treatment (CMT), spinal manipulative therapy (SMT), and other manual therapies used to diagnose, treat, and prevent injury or illness. Musculoskeletal Disorders (MSDs) are defined as conditions originating from joints, muscles, ligaments, discs, or other soft tissues of the spine or limbs that cause clinically relevant symptoms and functional limitations. The Description of Services clarifies common techniques (stretching, soft tissue mobilization, mobilization, manipulation, and craniosacral techniques) and notes that manipulation under anesthesia is out of scope for this policy.

High-level evidence summary

Overall evidence qualityMany studies small; majority low-to-moderate quality with heterogeneity

Musculoskeletal conclusionsOMT/SMT show small-to-moderate positive signals for some MSDs (low back, neck, shoulder, extremity); evidence variable and often limited

Non-musculoskeletal conclusionsInsufficient/high-quality evidence of benefit for non‑musculoskeletal disorders (no consistent effect)

References updated through

Definitions

Term	Definition
Manipulative Therapy	Therapeutic application of manual pressure or force in which the practitioner moves or manipulates one or more parts of the patient's body to achieve and maintain patient health; includes chiropractic treatments, physical therapy, and massage therapy.
Musculoskeletal Disorders (MSDs)	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 (e.g., ability to perform daily activities).
Upledger Technique	A complementary, light-touch, whole-body craniosacral treatment technique developed by John E. Upledger intended to work with the craniosacral system to support the central nervous system and alleviate aches, pains, and stress-related strain.
Craniosacral Therapy (CST)	A noninvasive osteopathic technique involving light touch to detect pulsations/rhythms of cerebrospinal fluid and gentle work on the skull and spine to release potential restrictions to cerebrospinal fluid flow; evidence is considered insufficient to support efficacy for most conditions.
Osteopathic Manipulative Treatment (OMT)	Hands-on techniques used by osteopathic physicians to diagnose, treat, and prevent illness or injury by moving patients' muscles and joints using stretching, gentle pressure, and resistance.
Spinal Manipulative Therapy (SMT)	Manual therapy involving thrust or mobilization techniques applied to the spine.
Upledger Technique	Definition added to the policy (full definition not included in this excerpt).

Revision History

2025-09-01policy_effectiveLatest

Policy revision effective date 09/01/2025. (Latest effective event)

2025-09-01added

Added language indicating chiropractic manipulative treatment for enrollees under 21 is medically necessary when referred by an EPSDT primary care provider. (Material change)

2025-09-01revised

Clarified chiropractic services for adults 21+ are covered for diagnosing and treating neuromusculoskeletal conditions associated with spinal functional integrity and that spinal manipulation up to five regions is medically necessary when included in the documented treatment plan. Initial visit/treatment plan and follow-up documentation requirements specified. (Material change)

Policy Summary

PayerUnitedHealthcare

PolicyManipulative Therapy (for Louisiana Only)

Policy CodePolicy CSOZ6LAM

Change TypeCoverage & criteria updates (age-based referral; adult treatment plan requirements; terminology)

Effective DateSep 1, 2025

Next Review Date

Key ActionAt the initial visit for adults 21 and older, document a treatment plan including level of care (duration/frequency), measures to assess effectiveness, and treatment goals.

On This Page

Treatment plan must include
- Level of care (duration and frequency of visits)
- Measures to assess the effectiveness of treatment (qualitative and/or quantitative)
- Treatment goals
Follow-up visits include information on enrollee progress and measures used to assess effectiveness
Manipulation limited to chiropractic spinal manipulation of up to five regions when included in the documented treatment plan

Chiropractic Services for Under 21 Years of Age

Covered when ALL of the following are met:

ALL of the following

Enrollee is under 21 years of age
Services are chiropractic manipulative treatment
Services are medically necessary
Services are upon referral from an EPSDT medical screening primary care provider

Chiropractic Services for Adults Age 21 and Older

Covered when ALL of the following are met:

ALL of the following

Enrollee is age 21 or older
Services are chiropractic services for diagnosing and treating neuromusculoskeletal conditions associated with the functional integrity of the spine
Chiropractic spinal manipulation of up to five regions is included in the documented treatment plan
Initial visit includes a treatment plan that documents: level of care (duration and frequency of visits), treatment goals, and measures to assess the effectiveness of treatment (qualitative and/or quantitative)
Follow-up visits include information on the enrollee's progress in the treatment plan and the measures used to assess effectiveness

Non State-Specific Criteria: Osteopathic Manipulative Services

Coverage and limitations for Osteopathic Manipulative Therapy (OMT):

Covered vs Not Covered

Medically necessary (covered): OMT is proven and medically necessary for treating Musculoskeletal Disorders (MSDs)
Not medically necessary (unproven / not covered): Manipulative Therapy is unproven and not medically necessary for all other indications due to insufficient evidence of efficacy; including but not limited to prevention/maintenance/custodial care and non-musculoskeletal disorders (e.g., asthma, otitis media, infantile colic, internal organ disorders)

Osteopathic Manipulative Therapy (General Position)

Covered when ALL of the following are met:

ALL of the following

Service is for treating musculoskeletal disorders (unless noted elsewhere as unproven and not medically necessary)

Manipulation under anesthesia is not addressed in this policy — separate policy applies

Manipulation under anesthesia is explicitly not addressed by this policy and is managed under a separate Manipulation Under Anesthesia policy. Craniosacral therapy (cranial manipulation / Upledger Technique) is listed among content mandated by the Louisiana Department of Health and is therefore specifically noted in the Instructions for Use. The policy distinguishes maintenance/preventive/custodial care from therapeutic care and states that prevention/maintenance/custodial uses of manipulative therapy are considered unproven and not medically necessary.

The policy also excludes or does not support many non‑musculoskeletal indications (for example asthma, otitis media, infantile colic) and nonstandard manipulative techniques (e.g., applied kinesiology, NUCCA); these are listed as not medically necessary or not addressed.

Prior Authorization

EPSDT referral requirement for under 21

For enrollees under 21 years of age, coverage for chiropractic services is conditional on medical necessity and requires a referral from an EPSDT medical screening primary care provider. Submit and maintain the EPSDT referral documentation in the enrollee's medical record to demonstrate coverage eligibility.

Coverage is conditional on medical necessity and a valid EPSDT medical screening primary care provider referral.

Billing Rule

LA Medicaid fee schedule exclusion note

Codes in this policy that are marked with an asterisk are not on the Louisiana Medicaid Fee Schedule and therefore are not covered by the State of Louisiana Medicaid Program. Do not bill these codes to LA Medicaid as they will not be reimbursed.

98925
98926
98927
98928
98929
98942
98943

Documentation Required

Use evidence when developing policies

When developing coverage policies or making payer/regulator decisions about spinal manipulative therapy (SMT) for non-musculoskeletal disorders, rely on systematic review evidence and high-quality syntheses of the literature. Policy determinations should be informed by the strength, consistency, and applicability of the available evidence.

References/accessed through 2025 (multiple clinical references listed)

Policy revision effective date09/01/2025

Multiple systematic reviews and randomized controlled trials summarized in the policy report small‑to‑moderate benefits of OMT/SMT for several musculoskeletal conditions (for example low back pain, neck pain, shoulder and extremity disorders), with the overall quality of evidence typically rated low to moderate. Safety signals are limited, with most reported adverse events being transient musculoskeletal complaints.

The policy therefore characterizes the evidence as mixed but supportive of therapeutic use for select MSDs while noting variable quality and the need for further high‑quality trials.

2025-09-01revised

Terminology change: replaced 'Manipulative Therapy' with 'osteopathic Manipulative Therapy' as proven and medically necessary for treating Musculoskeletal Disorders (except as noted). (Material change)

2025-09-01added

Added definition of 'Upledger Technique' to the Definitions section. (Non-material change)

2025-09-01updated

Updated Clinical Evidence and References sections and archived previous policy version CSOZ6LAL. (Non-material change)