Aetna Coverage For Chiropractic Services Explained (2022)
Aetna covers chiropractic manipulation if they are medically necessary and meet the three criteria described below.
1. Does Aetna Cover Chiropractic Services?
Yes. Aetna covers chiropractic services if they are medically necessary. The three criteria need to be met to get chiropractic services covered.
- The documentation explains the improvement of the patient and is documented within the initial two weeks.
- The documentation proves the medical necessity of chiropractic treatment.
- The patient is diagnosed with a neuromusculoskeletal disorder.
2. Chiropractic Services Not Covered By Aetna
Aetna does not cover chiropractic services if there is no improvement after two weeks, and additional treatment is considered. The only exception would be a modification of the treatment.
The first 30 days are covered if chiropractic treatment is modified after two weeks. However, Aetna won’t cover this service after 30 days if there is no improvement and therefore considered not medically necessary.
Continuing chiropractic care is not covered because it is not medically necessary. This type of care is provided once the maximum therapeutic benefit has been achieved.
Chiropractic manipulation for treating idiopathic scoliosis or scoliosis beyond early adolescence is not covered unless the patient exhibits pains, spasms, or other indications that show that the patient needs chiropractic manipulation.
Aetna does not cover chiropractic services for infants because they are considered investigational and experimental unless used for neuromusculoskeletal indications.
Aetna does not cover chiropractic manipulation for non-neuromusculoskeletal conditions because the effectiveness is unproven. Examples are epilepsy or dysmenorrhea.
Patients with conditions that are treated with chiropractic services but do not improve or regress are not covered by Aetna.
Aetna does not cover chiropractic manipulation for asymptomatic patients or someone without an identifiable clinical condition.
4. References
https://www.aetna.com/cpb/medical/data/100_199/0107.html
