Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES
Chapter 5 - CHIROPRACTIC SERVICES
Section 471-5-003 - SERVICE REQUIREMENTS
Universal Citation: 471 NE Admin Rules and Regs ch 5 ยง 003
Current through September 17, 2024
003.01 GENERAL REQUIREMENTS.
003.01(A)
MEDICAL
NECESSITY. Medicaid incorporates the definition of medical
necessity from 471 NAC 1 as is fully rewritten herein. Services and supplies
that do not meet the 471 NAC 1 definition of medical necessity are not
covered.
003.01(B)
SERVICES PROVIDED FOR CLIENTS ENROLLED IN NEBRASKA MEDICAID MANAGED
CARE. See 471 NAC 1.
003.01(C)
HEALTH CHECK SERVICES.
See 471 NAC 33.
003.02 COVERED SERVICES. Medicaid limits coverage of chiropractic services to:
(i) Certain spinal x-rays;
(ii) Manual manipulation of the
spine;
(iii) Certain evaluation and
management services;
(iv)
Traction;
(v) Electrical
stimulation;
(vi) Ultrasound;
and
(vii) Certain therapeutic
procedures, activities, and techniques designed and implemented to improve,
develop, or maintain the function of the area treated.
003.02(A)
CHIROPRACTIC
TREATMENT. Covered services are only for the treatment of spinal
subluxations for which treatment provides a direct therapeutic benefit, and is
subject to the following limitations:
(i) For
clients age 21 and older, chiropractic treatment is limited to those treatments
deemed medically necessary;
(ii)
For clients age 20 and younger, chiropractic treatment is limited to those
treatments deemed medically necessary; and
(iii) No more than one treatment per client
per day is covered.
003.02(B)
SPINAL
X-RAYS. Coverage of spinal x-rays is limited to one
anteroposterior and one lateral view of the entire spine or one each of the
following: thoracic, cervical, and lumbosacral for a client in a 12 month
period. For spinal x-rays to be covered under Medicaid, at least one of the
following criteria must be met:
(i) Recent
acute or violent trauma where there may be a question concerning avulsion,
fracture, or subluxation;
(ii)
Chronic or long-standing ailments that have been treated by other practitioners
without success and, if x-rays were already taken, they are not
available;
(iii) When there is a
pathology or malignancy previously diagnosed, precautionary x-rays are covered
when medically necessary;
(iv) If
there is any indication of existing pathology in the evaluation of the client,
the treatment of which may cause additional discomfort;
(v) If the client has been under long-term
treatment with no alleviation of symptoms; or
(vi) When specifically required by the
Department's utilization review and for documentation of diagnosis and claims
for services.
003.03 NON-COVERED SERVICES. Except for those services previously specified, Medicaid does not cover any other diagnostic or therapeutic service or supply provided by a chiropractor.
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