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Children's Chiropractic Services Manual

Children's Chiropractic Services Manual

This manual is a DRAFT and IS NOT IN EFFECT.
Please visit the appropriate provider type page for the manual that is in force at this time.

Children's Chiropractic Services Manual

Printing the manual material found at this website for long-term use is not advisable. Department Policy material is updated periodically and it is the responsibility of the users to check and make sure that the policy they are researching or applying has the correct effective date for their circumstances.

If you experience any difficulty opening a section or link from this page, please email the webmaster.

How to Search this manual:

This edition has three search options.

  1. Search the whole manual. Open the Complete Manual pane.  From your keyboard press the Ctrl and F keys at the same time.  A search box will appear.  Type in a descriptive or key word (for example "Denials". The search box will show all locations where denials discussed in the manual.
  2. Search by Chapter. Open any Chapter tab (for example the "Billing Procedures" tab).  From your keyboard press the Ctrl and F keys at the same time.  A search box will appear.  Type in a descriptive or key word (for example "Denials". The search box will show where denials discussed in just that chapter.
  3. Site SearchSearch the manual as well as other documents related to a particular search term on the Montana Healthcare Programs Site Specific Search page.

Prior manuals may be located through the provider website archives.

 


Children's Chiropractic Services Manual

Updated 06/20/2017

This manual was updated 06/20/2017

Update Log

Update Log

 

Publication History

This publication supersedes all previous Physician-Related Services handbooks. Published by the Montana Department of Public Health & Human Services, January 2005.

 Updated June 2017.

CPT codes, descriptions and other data only are copyright 2014 American Medical Association (or such other date of publication of CPT). All Rights reserved. Applicable FARS/DFARS Apply.

Update Log

06/20/2017
Children's Chiropractic Services Manual converted to an HTML format and adapted to 508 Accessibility Standards.

 

End of Update Log Chapter

Table of Contents

Chiropractic Services

Chiropractic Services

 

General Overview

Chiropractic services are rendered by providers enrolled with Montana Medicaid and are billed through Xerox State Healthcare LLC, the Department’s fiscal agent. Chiropractic services payable by Montana Medicaid are limited to those provided to children age 20 and under (also referred to as EPSDT) for medically necessary services.

Medicaid does not reimburse for any chiropractic services provided to individuals age 21 and over.

This manual is to be used in conjunction with the General Information for Providers manual, other appropriate Montana Medicaid provider manuals, Administrative Rules of Montana, and Department fee schedules.

Definitions

Chiropractic Services. The manipulation of the spine by a licensed chiropractor in accordance with the laws of the state in which he/she is practicing. Administrative Rule of Montana (ARM) 37.86.2211 states that chiropractic services are limited to evaluation and management office visits, manual manipulation of the spine, and x-rays to support the diagnosis of subluxation of the spine.

Benefits and Limitations

Payment for chiropractic services provided to individuals age 20 and under is limited to evaluation and management office visits, manual manipulation of the spine, and x-rays to support diagnosis of subluxation of the spine.

The Department maintains the right to review claims for medical necessity. Refer to ARM 37.85.414, Maintenance of Records and Auditing for further information.

Medicaid Eligibility

Providers are required to confirm Medicaid eligibility for individuals age 20 and under. For enrolled providers, Montana Medicaid offers different methods to confirm eligibility. For methods and details on each, see the Member Eligibility and Responsibilities chapter in the General Information for Providers manual, available on the Provider Information website.

1 (800) 624-3958  Provider Relations
1 (800) 714-0060  Integrated Voice Response (IVR) (24 hours)
1 (800) 714-0075  FaxBack

MATH Web Portal:  https://mtaccesstohealth.acs-shc.com/

 

End of Chiropractic Services Chapter

Billing Procedures

Billing Procedures

 

For current billing procedures, please see the Billing Procedures chapter of the General Information for Providers manual on the Provider Information website.

Passport

For members with a Passport designation on the Medicaid ID card, chiropractors must obtain a referral from the member’s Passport provider. For more information, see the Passport to Health manual, available on the Provider Information website.

Reimbursement

For chiropractic services for children age 20 and under, the Department will pay the lowest of:

  • The provider’s actual (submitted) charge for the service; or
  • The Department’s fee schedule reimbursement, as specified in the Resource-Based Relative Value Scale (RBRVS).

The Children’s Chiropractic fee schedule is available on the Chiropractic page of the Provider Information website.

In the menu on the left, select the Resources by Provider Type link. Read the End User Agreement and click the I Agree option to access the list of provider pages. Scroll to the Chiropractic entry and click on it to access the resources available for that provider type. The fee schedule is in the pane titled Fee Schedules – Children’s Chiropractic. In the menu on the left, select the Resources by Provider Type link. Read the End User Agreement and click the I Agree option to access the list of provider pages. Scroll to the Chiropractic entry and click on it to access the resources available for that provider type. The fee schedule is in the pane titled Fee Schedules – Children’s Chiropractic.

Procedure Codes

Refer to the Provider Information website. Click on Resources by Provider Type in the menu on the left. Read the End User Agreement and click the I Agree option to access the list of provider pages. Scroll to the Chiropractic entry and click on it to access the resources available for that provider type. See the Other Resources pane.

 

End of Billing Procedures Chapter

Index

Index

Previous editions of this manual contained an index.

This edition has three search options.

1.Search the whole manual. Open the Complete Manual pane.  From your keyboard press the Ctrl and F keys at the same time.  A search box will appear.  Type in a descriptive or key word (for example "Denials". The search box will show all locations where denials discussed in the manual.

2.Search by Chapter. Open any Chapter tab (for example the "Billing Procedures" tab).  From your keyboard press the Ctrl and F keys at the same time.  A search box will appear.  Type in a descriptive or key word (for example "Denials". The search box will show where denials discussed in just that chapter.

3.Site Search.  Search the manual as well as other documents related to a particular search term on the Montana Healthcare Programs Site Specific Search page.

 

End of Index Chapter

End of Children's Chiropractic Services Manual

Complete Children's Chiropractic Services Manual

Update Log

 

Publication History

This publication supersedes all previous Physician-Related Services handbooks. Published by the Montana Department of Public Health & Human Services, January 2005.

 Updated June 2017.

CPT codes, descriptions and other data only are copyright 2014 American Medical Association (or such other date of publication of CPT). All Rights reserved. Applicable FARS/DFARS Apply.

Update Log

06/20/2017
Children's Chiropractic Services Manual converted to an HTML format and adapted to 508 Accessibility Standards.

 

End of Update Log Chapter

 

Table of Contents

 

Chiropractic Services

General Overview

Definitions

Benefits and Limitations

Medicaid Eligibility

Billing Procedures

Passport

Reimbursement

Procedure Codes

 

End of Table of Contents Chapter

 

Chiropractic Services

 

General Overview

Chiropractic services are rendered by providers enrolled with Montana Medicaid and are billed through Xerox State Healthcare LLC, the Department’s fiscal agent. Chiropractic services payable by Montana Medicaid are limited to those provided to children age 20 and under (also referred to as EPSDT) for medically necessary services.

Medicaid does not reimburse for any chiropractic services provided to individuals age 21 and over.

This manual is to be used in conjunction with the General Information for Providers manual, other appropriate Montana Medicaid provider manuals, Administrative Rules of Montana, and Department fee schedules.

Definitions

Chiropractic Services. The manipulation of the spine by a licensed chiropractor in accordance with the laws of the state in which he/she is practicing. Administrative Rule of Montana (ARM) 37.86.2211 states that chiropractic services are limited to evaluation and management office visits, manual manipulation of the spine, and x-rays to support the diagnosis of subluxation of the spine.

Benefits and Limitations

Payment for chiropractic services provided to individuals age 20 and under is limited to evaluation and management office visits, manual manipulation of the spine, and x-rays to support diagnosis of subluxation of the spine.

The Department maintains the right to review claims for medical necessity. Refer to ARM 37.85.414, Maintenance of Records and Auditing for further information.

Medicaid Eligibility

Providers are required to confirm Medicaid eligibility for individuals age 20 and under. For enrolled providers, Montana Medicaid offers different methods to confirm eligibility. For methods and details on each, see the Member Eligibility and Responsibilities chapter in the General Information for Providers manual, available on the Provider Information website.

1 (800) 624-3958  Provider Relations
1 (800) 714-0060  Integrated Voice Response (IVR) (24 hours)
1 (800) 714-0075  FaxBack

MATH Web Portal:  https://mtaccesstohealth.acs-shc.com/

 

End of Chiropractic Services Chapter

 

Billing Procedures

 

For current billing procedures, please see the Billing Procedures chapter of the General Information for Providers manual on the Provider Information website.

Passport

For members with a Passport designation on the Medicaid ID card, chiropractors must obtain a referral from the member’s Passport provider. For more information, see the Passport to Health manual, available on the Provider Information website.

Reimbursement

For chiropractic services for children age 20 and under, the Department will pay the lowest of:

  • The provider’s actual (submitted) charge for the service; or
  • The Department’s fee schedule reimbursement, as specified in the Resource-Based Relative Value Scale (RBRVS).

The Children’s Chiropractic fee schedule is available on the Chiropractic page of the Provider Information website.

In the menu on the left, select the Resources by Provider Type link. Read the End User Agreement and click the I Agree option to access the list of provider pages. Scroll to the Chiropractic entry and click on it to access the resources available for that provider type. The fee schedule is in the pane titled Fee Schedules – Children’s Chiropractic. In the menu on the left, select the Resources by Provider Type link. Read the End User Agreement and click the I Agree option to access the list of provider pages. Scroll to the Chiropractic entry and click on it to access the resources available for that provider type. The fee schedule is in the pane titled Fee Schedules – Children’s Chiropractic.

Procedure Codes

Refer to the Provider Information website. Click on Resources by Provider Type in the menu on the left. Read the End User Agreement and click the I Agree option to access the list of provider pages. Scroll to the Chiropractic entry and click on it to access the resources available for that provider type. See the Other Resources pane.

 

End of Billing Procedures Chapter

 

Index

Previous editions of this manual contained an index.

This edition has three search options.

1.Search the whole manual. Open the Complete Manual pane.  From your keyboard press the Ctrl and F keys at the same time.  A search box will appear.  Type in a descriptive or key word (for example "Denials". The search box will show all locations where denials discussed in the manual.

2.Search by Chapter. Open any Chapter tab (for example the "Billing Procedures" tab).  From your keyboard press the Ctrl and F keys at the same time.  A search box will appear.  Type in a descriptive or key word (for example "Denials". The search box will show where denials discussed in just that chapter.

3.Site Search.  Search the manual as well as other documents related to a particular search term on the Montana Healthcare Programs Site Specific Search page.

 

End of Index Chapter

End of Children's Chiropractic Services Manual