Does Medicaid Pay For Chiropractors?

Does Medicaid Pay For Chiropractors?

Last Updated on February 27, 2022 by Anne-Sophie Reinhardt

Patients who need chiropractic care find it difficult to understand the extent of Medicaid’s chiropractic coverage. We keep asking, “Does Medicaid Pay For Chiropractors?”.

And, the answer is which State you live in will determine if Medicaid covers chiropractic care, which means each state has its eligibility criteria for chiropractic care.

Because Medicaid is a state-by-state program, it is more governed by state laws than federal laws. The US state recognises he importance of chiropractic care is being recognised by, seeing an increase in spinal problems.

Medicaid also saves money because it pays for chiropractic care when it is not as severe. This allows you to avoid waiting until the worst happens, take pain medication, or even go to the emergency room.

What Is Chiropractic Care?

Chiropractic care involves a doctor or chiropractor applying a controlled force to a spine joint using their hands. This procedure improves spinal movement and enhances the body’s physical purpose.

Therapist, Chiropractor
Chiropractic care involves a doctor or chiropractor applying a controlled force to a spine joint using their hands

Chiropractic care believes that alignment of the spine will allow the body to heal itself naturally without the need for drugs or surgery. Manipulation can restore movement to damaged joints due to traumatic events like sitting without back support.

Chiropractors primarily use this technique to relieve pain in the bones, muscles, joints and connective tissues such as ligaments, tendons and cartilage.

Who Qualifies for Chiropractic Care Under Medicaid?

You must show your Medicaid ID card to receive any Medicaid services because this ID card serves to confirm your eligibility for the particular Medicaid healthcare service. Who is eligible for chiropractic care under Medicaid

  1. Chiropractic care is a mandatory benefit for Medicaid recipients who have EPSDT (Early Periodic Screening Diagnosis Treatment). This applies to pregnant women in the third trimester and children six years or older.
  2. A qualified doctor approved by Medicaid may offer chiropractic care to patients over 21 years old. Medicaid will not pay for more than one treatment per person per day.

Which Chiropractic Care Services Do Medicaid Cover?

When deemed medically necessary, Medicaid covers chiropractic care services. These services include examinations and diagnoses that can influence the neurophysiological function in the spine region.

Medicaid covers these chiropractic services:

Chronic Back Pain

If you are suffering from chronic back pain, chiropractic care may be the best option. There are many chiropractic treatments that can help you manage chronic back pain, such as a herniated disk.

MSD (musculoskeletal disorders) is a condition that chiropractors can diagnose and treat. They will also recommend a treatment plan and refer you to a specialist, such as a surgeon. Spinal manipulation and spinal mobilization are two of the many treatments that Medicaid covers for chronic back pain.

Neck pain

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Neck pain is often caused by poor posture, age-related wear, and poor sitting and sleeping habits.

So, chiropractic neck adjustments, or cervical spine manipulation, is a procedure that aims to loosen the cervical vertebrae’s joints. As a result, this can reduce the pain from muscle spasms and pinched nerves.

Spinal X-Rays

Medicaid covers spinal x-rays if the procedure is medically necessary. The procedure can only be done on one side and end of the entire spine.

To qualify for Medicaid reimbursement of your spinal x-ray, you must meet at least one condition:

  1. Present severe or intense trauma, where there may be a concern with fracture, avulsion spinal subluxation.
  2. Chronic or pre-existing conditions that qualified doctors have not treated.
  3. If there is a suspected malignancy or other pathology, it can be covered with precautionary spinal radiographs.
  4. A patient should be diagnosed if they have a sign of an existing malignancy.
  5. A patient who has had long-term spinal therapy with no decrease in symptoms.

Which Chiropractic Care Services Don’t Medicaid Cover?

Medicaid will not pay for other services if it’s not those listed above, unless approved by Medicaid.

Do You Need Prior Authorization for Medicaid to Pay For Your Chiropractors?

You only have 12 visits annually to a chiropractor if you have Medicaid coverage. Additional visits require authorisation in writing from your local Medicaid office.

Medicaid will not pay for chiropractic care if you have prior authorisation from your local clinic. However, there are exceptions to the rule if you have the appropriate documentation and if the care is urgent or retro-eligible.

Retroactive eligibility refers to a period of three consecutive months preceding the month in which patients fill the Medicaid request. This is when you are eligible for Medicaid coverage, as determined by your local Medicaid office.

Please note, however, that Medicaid will not pay for services rendered if it exceeds the time frame stated in the prior authorisation document.

Does Medicaid Pay For Chiropractors? Yes, But…

If you have chronic neck and back pains, you may be able to see a chiropractor. Medicaid may pay for these treatments depending on where you live. Chiropractic care is a mandatory Medicaid benefit for pregnant mothers in the third trimester, and children aged six years or less. You can check to see if your plan covers chiropractic care.

However, if you have a Medicare Insurance plan, does Medicare cover chiropractic care?

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