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November 18, 2017

Chiropractic Services

House bill 260, passed by the 2011 Idaho legislature, directs the Department to limit chiropractic services to six visits per calendar year for treatment involving the manipulation of the spine to correct a subluxation condition. Idaho rule defines subluxation as partial or incomplete dislocation of the spine. If medical necessity is documented, additional visits may be approved with a prior authorization.

The following documentation is needed to determine the need for additional visits:

  • Completed Medical Prior Authorization Form – Please document on the form the number of visits being requested. CPT codes should be included not ICD codes. Failure to provide this information will delay the process of the request.
  • Chiropractic evaluation completed within the past year.

  • Current plan of care (POC) signed and dated by the chiropractor, physician or mid-level. The plan should include:

    •  Diagnosis;

    •  Anticipated long and short term goals with measurable objectives;

    •  Frequency of treatment;

    •  Expected duration of treatment;

    •  Treatment notes for previous 30 days.

Failure to submit the above information may result in a processing delay, or denial, for incomplete documentation.

The status of a prior authorization request may be checked online at the Molina Health PAS portal under “Authorization Status”, using your NPI, or by contacting Molina at (866) 686-4272. 

Contact

Chiropractic Services

 Phone: 1 (866) 205-7403
Fax: 1 (877) 314-8779