![]() ![]() CPB 0388 - Complementary and Alternative Medicine.CPB 0204 - Manipulation Under General Anesthesia.CPB 0112 - Surface Scanning and Macro Electromyography.Please check benefit plan descriptions for details. Note: Some plans have limitations or exclusions applicable to chiropractic care. Thermography (see CPB 0029 - Thermography).Spinoscopy (see CPB 0112 - Surface Scanning and Macro Electromyography).Para-spinal electromyography (EMG) / Surface scanning EMG (see CPB 0112 - Surface Scanning and Macro Electromyography).Neurocalometer/Nervoscope (see CPB 0029 - Thermography).Dynamic spinal visualization (including digital motion x-ray and videofluoroscopy, also known as cineradiography).Computerized radiographic mensuration analysis for assessing spinal mal-alignment. ![]() Whitcomb Technique (see CPB 0388 - Complementary and Alternative Medicine).Upledger Technique and Cranio-Sacral Therapy.Spinal Adjusting Devices (Activator, ProAdjuster, PulStarFRAS, Ultralign adjusting device).NUCCA (National Upper Cervical Chiropractic Association) procedure.Manipulation Under Anesthesia (see CPB 0204 - Manipulation Under General Anesthesia).Manipulation for internal (non-neuromusculoskeletal) disorders (Applied Kinesiology).Inertial traction (inertial extensilizer decompression table.FAKTR (Functional and Kinetic Treatment with Rehab) Approach.Cox decompression manipulation/technique.ConnecTX (an instrument-assisted connective tissue therapy program).Coccygeal Meningeal Stress Fixation Technique.Chiropractic Biophysics Technique / Chiropractic BioPhysics Methods.Applied Spinal Biomechanical Engineering.Advanced Biostructural Correction (ABC) Chiropractic Technique.Active Release Technique (see CPB 0388 - Complementary and Alternative Medicine).Infants with gastro-intestinal disorders including constipation.Manipulation of infants for non-neuromusculoskeletal indications (see examples below, not an all-inclusive list):.Menopause-associated vasomotor symptoms.Attention-deficit hyperactivity disorder.Manipulation when it is rendered for non-neuromusculoskeletal conditions (see examples below, not an all-inclusive list):.Chiropractic care in persons, whose condition is neither regressing nor improving, is considered not medically necessary.Ĭhiropractic manipulation has no proven value for treatment of idiopathic scoliosis or for treatment of scoliosis beyond early adolescence, unless the member is exhibiting pain or spasm, or some other medically necessary indications for chiropractic manipulation are present.Īetna considers the following procedures experimental and investigational:.Chiropractic manipulation in asymptomatic persons or in persons without an identifiable clinical condition is considered not medically necessary.This may be considered medically necessary in the transition of the member from hospital to home, and may be an extension of case management services. Home-based chiropractic service is considered medically necessary in selected cases based upon the member's needs (i.e., the member must be homebound).Once the maximum therapeutic benefit has been achieved, continuing chiropractic care is considered not medically necessary. If no improvement is documented within 30 days despite modification of chiropractic treatment, continued chiropractic treatment is considered not medically necessary. If no improvement is documented within the initial 2 weeks, additional chiropractic treatment is considered not medically necessary unless the chiropractic treatment is modified. Improvement is documented within the initial 2 weeks of chiropractic care.The medical necessity for treatment is clearly documented and.The member has a neuromusculoskeletal disorder and.This Clinical Policy Bulletin addresses chiropractic services.Īetna considers chiropractic services medically necessary when all of the following criteria are met: ![]() Number: 0107 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References ![]()
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