Service Limitations

(A) The MassHealth agency pays for medically necessary chiropractic treatment related to a neuromusculoskeletal condition only. Services must have a direct therapeutic relation to the patient’s condition and must be provided by the chiropractor in the chiropractor's office, or in the case of a MassHealth-enrolled CHC billing for chiropractor services provided on site by a CHC- employed or contracted chiropractor, at the CHC. Conditions that may be considered to provide therapeutic grounds for chiropractic treatment include functional disabilities of the spine, nerve pains, and documented incidents that produce sprains and strains of the spinal axis. (B) The MassHealth agency does not pay for both an office visit and chiropractic manipulative treatment provided to a MassHealth member on the same day. This limitation does not apply to a significant, separately identifiable office visit provided by the same chiropractor on the same day of the procedure or other service. (C) The MassHealth agency limits payment for chiropractor services to a total of 20 office visits or chiropractic manipulative treatments, or any combination of office visits and chiropractic manipulative treatments, up to a total of 20, per member per calendar year, without prior authorization. Office visits and chiropractic manipulative treatments above these limits require prior authorization in accordance with 130 CMR 441.411. (See 130 CMR 441.409 for limits on radiology services.)