Children's Chiropractic Services Manual
To print this manual, right click your mouse and choose "print". 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.
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 Conduent, 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.
Medical necessity must be documented by the child's primary care provider, and treatment must be directly related to a neuromuscular condition 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.portal.conduent.com/mt/general/home.do
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