Prior Authorization

(A) Services that Require Prior Authorization. The MassHealth agency requires that the chiropractor obtain prior authorization as a prerequisite to payment for more than 20 office visits or chiropractic manipulative treatments, or any combination of office visits and chiropractic manipulative treatments, above a total of 20, per member per calendar year. (B) Submission Requirement. The chiropractor must submit all prior-authorization requests in accordance with the billing instructions in Subchapter 5 of the Chiropractor Manual. Prior authorization determines only the medical necessity of the authorized service, and does not establish or waive any other prerequisites for payment such as member eligibility or resort to health insurance payment. See 130 CMR 450.303: Prior Authorization for additional information about prior authorization.