Three policies are changing for chiropractic services.
Our commitment is to update the provider community as policies and guidelines are added, adopted, revised and/or archived.
The below changes will be effective April 1, 2024.
Coding and Reimbursement Policy Changes
- Chiropractic Services - This policy is being updated to incorporate the Medicaid Expansion allowance of Evaluation and Management (E/M) codes 99211-99213 which were added into the Manipulation Services (Medicaid Expansion) medical policy.
- Due to this, the policy will now be applicable from a correct coding perspective to Medicaid Expansion claims.
- Medicaid Expansion Chiropractic Services – This policy is being archived. Coverage rules regarding E/M and Chiropractic Manipulation Treatment (CMT) services were moved to the Medical Policy Manipulation Services (Medicaid Expansion) Policy effective April 1, 2024.
Medical Policy Changes
- Medicaid Expansion coverage rules regarding E/M and CMT services were moved to the Manipulation Services (Medicaid Expansion) medical policy.
- Claims submitted prior to April 1, 2024, will not allow payment for established patient E/M with manipulation.
- Medicaid Expansion members are allowed five established patient E/M services with manipulation per year.
- The CMT services have a limitation of 20 services per calendar year for Medicaid Expansion members have been included in the policy.
- Lastly, the policy application section has been added to the policy for transparency.
- To learn more about the Policy Application refer to the following HealthCare News (HCN) article: Policy Application Language Transparency.
Questions?
Contact our Medicaid Expansion Provider Service Center at 1-833-777-5779 or email prov.partners@bcbsnd.com.
