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Medicaid Reimbursement for Chiropractic Services


Medicaid reimburses for services rendered by licensed, Medicaid-participating chiropractors. Medicaid reimbursable services include a new patient visit, manipulation of the spine, and spinal x-rays. The new patient visit consists of a screening and any required manipulation of the spine.

LIMITATIONS:

Medicaid reimbursement for chiropractic services is limited to one visit per provider, per recipient, per day.

A new patient visit is limited to one per provider, per recipient. A new patient is one who has not received any professional services from the provider or provider group within the past three years.

Visits are limited to a total of 24 during a calendar year. Medicaid does not reimburse massage or heat treatments.

EXCEPTIONS:

The provider may request authorization for reimbursement for services in excess of the service limitations for recipients under the age of 21.

ELIGIBILITY:

Medicaid reimburses for chiropractic services for all Medicaid recipients.

REIMBURSEMENT:

Medicaid reimbursement for chiropractic services is the maximum Medicaid fee or the provider’s customary fee, whichever is lower.

There is a $1 recipient copayment for chiropractic services, per provider, per day, unless the recipient is exempt.

See also:

List of CPT codes Chiropractic services

Aetna insurance reimbursement for Chiropractic services

Cigna insurance reimbursement for Chiropractic services

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