Conditions For Cigna Chiropractic Coverage
CIGNA covers chiropractic manipulation and adjunct therapeutic procedures/modalities (e.g., mobilization, therapeutic exercise, traction) as medically necessary when ALL of the following conditions are met:
- A neuromusculoskeletal condition is diagnosed that may be relieved by standard chiropractic treatment in order to restore optimal function.
- Cigna Chiropractor care is being performed by a licensed doctor of chiropractic who is practicing within the scope of his/her license as defined by state law.
Documentation For CIGNA Chiropractic Coverage
Cigna covers chiropractic care if individual is involved in a chiropractic treatment program that clearly documents all of the following:
- A prescribed treatment program that is expected to result in significant therapeutic improvement over a clearly defined period of time.
- The symptoms being treated.
- Diagnostic procedures and results.
- Frequency, duration and results of planned treatment modalities.
- Anticipated length of treatment plan with identification of quantifiable, attainable short-term and long-term goals.
- Demonstrated progress toward significant functional gains and/or improved activity tolerances.
CIGNA Does Not Cover Chiropractic Care If Not Considered Medically Necessary
CIGNA does not cover chiropractic manipulation and adjunct therapeutic procedures/modalities (e.g., mobilization, therapeutic exercise, traction) for ANY of the following, as they are considered not medically necessary:
- For manipulations or modalities that are not related to the individual’s symptoms, not likely to result in sustained improvement, or do not have defined endpoints, including maintenance, preventive or supportive care or care provided to prevent reoccurrences or slow deterioration.
- Services provided to reduce potential risk factors where significant improvement is not expected.
- For duplicated services, when provided by a physical therapist or other health professional.
CIGNA Does Not Cover Treatments That Are Experimental, Investigational or Unproven
CIGNA does not cover chiropractic manipulation and adjunct therapeutic procedures/modalities (e.g., mobilization, therapeutic exercise, traction) for treatment of non-neuromusculoskeletal conditions because it is considered experimental, investigational or unproven.
Non covered CPT codes
CPT S8990: Physical or manipulative therapy performed for maintenance rather than restoration.
CPT 76499: Unlisted diagnostic radiographic procedure
CPT 97750: Physical performance test or measurement (eg, musculoskeletal, functional capacity), with written report, each 15 minutes.
CPT 99090: Analysis of clinical data stored in computers (eg, ECGs, blood pressures, hematologic data)
For more informations of coverage limitations please refer Cigna Coverage Policy