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CHIROPRACTIC PROGRAMNovember and December, 2019
Chiropractic MedicineEffective January 1, 202013.70 CHIROPRACTIC MEDICINE13.70.A COVERED SERVICESChiropractic services are limited to examinations, diagnoses, adjustments,manipulations and treatments of malpositioned articulations, and structuresof the body provided by licensed chiropractic physicians practicing withintheir scope of practice.2
13.70.B ELIGIBLE PROVIDERS Provider must be licensed to practice chiropractic by complying with theprovisions of Chapter 331, RSMo Have signed a participation agreement to provide chiropractic servicesunder the MO HealthNet program.13.70.C ELIGIBLE PARTICIPANTS MO HealthNet Eligible13.70.D LIMITATIONS Participants may receive up to 20 visits per year for chiropractic services.{11/06/19 per policy: 20 visits per ROLLING year}Source: http://manuals.momed.com/collections/collection phy/print.pd
Covered CPT CodesPROCEDURECODESERVICEREIMBURSEMENT99201New Patient – Office or otheroutpatient visit for the evaluationand management of a new patient 25.32 per unit99202New Patient – Office or otheroutpatient visit for the evaluationand management of a new patient 44.98 per unit99203New Patient – Office or otheroutpatient visit for the evaluationand management of a new patient 66.99 per unit4
PROCEDURECODESERVICEREIMBURSEMENT99204New Patient – Office or otheroutpatient visit for the evaluationand management of a new patient 94.87 per unit99205New Patient – Office or otheroutpatient visit for the evaluationand management of a new patient 120.72 per unit99211Office or other outpatient visit 15.31 per unitfor the evaluation andmanagement of a established patient5
PROCEDURECODESERVICEREIMBURSEMENT99212Office or other outpatient visit 26.59 per unitfor the evaluation andmanagement of a established patient99213Office or other outpatient visit 38.93 per unitfor the evaluation andmanagement of a established patient99214Office or other outpatient visit 58.57 per unitfor the evaluation andmanagement of a established patient6
PROCEDURECODESERVICEREIMBURSEMENT99215Office or other outpatient visit 83.12 per unitfor the evaluation andmanagement of a established patient97012Traction, mechanical 9.23 per unit97014Electrical stimulation(unattended) 2.68 per unit97032Application of a modality to one 10.18 per unitor more areas; electrical stimulation(manual), each 15 minutes7
PROCEDURECODESERVICEREIMBURSEMENT97035Ultrasound, each 15 minutes98940Chiropractic manipulative treatment(CMT); spinal, one to two regions 7.25 per unit98941 Spinal, three to four regions98942Spinal, five regions98943Extraspinal, one or more regions8
DISCLAIMER:These CPT codes have been updated with the 2019 Physician Fee Increasesas of July 1, 2019.Consult the MO HealthNet on-line Fee Schedule for current allowed amounts.9
Chiropractic CredentialsA MO HealthNet enrolled Physician who is licensed toprovide Chiropractic services, [2 separate licenses] canenroll under two provider types; provider type 20 forphysician and provider type 23 for chiropractor.Should provider choose to use the same NPI they wouldsupply a separate taxonomy code for each provider type orthey obtain a separate NPI for each in which casetaxonomy codes are not required.10
Chiropractic Credentials (cont.)Chiropractors currently can enroll as a Qualified Medicare Beneficiary(QMB) provider type 75 and specialty 35. However, should they wishto enroll under the 23 provider type they will need to do one of thefollowing: Dis-enroll their currently enrolled 75 number or; Enroll with a new National Provider Identifier (NPI) for their 23provider # or; If the provider is enrolling under the same NPI as the QMBenrollment, a different taxonomy code is required for each.11
Provider EnrollmentIf a qualified provider is not already enrolled with the MHD as a provider, anenrollment application must be submitted. The link to compete the electronicapplication ommongui/PeHome.jspAny questions regarding enrollment should be emailed to:MMAC.ProviderEnrollment@dss.mo.gov12
Contact InformationProvider Communication Unit (WIPRO): (573) 751-2896Constituent Education Unit: (573) 751-6683Email: MHD.PROVTRAIN@dss.mo.gov13
Contact Information forManaged Care PlansFor providers who have questions regarding chiropractic coverage for theManaged Care participants they may contact the Managed Care Plans directly at:Or contact:Managed Care Provider Communications:Email: MHD.MCCommunications@dss.mo.gov14
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Chiropractic Medicine Effective January 1, 2020 13.70 CHIROPRACTIC MEDICINE 13.70.A COVERED SERVICES Chiropractic services are limited to examinations, diagnoses, adjustments, manipulations and treatments of malpositioned articulations, and structures of the body provided by licensed chiropractic physicians practicing within their scope of .
