Chiropractic

Below are general guidelines for chiropractic services:

  • A claim has one window period, which encompasses all accepted body parts
  • Prior authorization is required for all treatment extending beyond the window period
  • Physician referral does not waive prior authorization requirements
  • Changing chiropractors during the course of treatment does not start a new window period

Chiropractic Window Period

WSI defines the window period* as a period of initial chiropractic treatment on a claim not requiring prior authorization.  Each window period includes:

  • 6 visits or 60 days of care, whichever comes first, including the initial evaluation
  • Treatment of all body parts accepted on a claim
  • Up to 2 modalities per visit

The window period does not allow reimbursement for massage/manual therapy when performed with the manipulation on the same spinal region on the same visit.

*Effective January 1, 2016, WSI altered the chiropractic pilot program to include a window period.

Submitting a Prior Authorization Request for Chiropractic Services

A chiropractor must request prior authorization for treatment occurring outside the window period.  To complete a request for prior authorization:

Submitting a Prior Authorization Request for Palliative Care

A chiropractor must request prior authorization for palliative care.  To complete a request for prior authorization:

For more information about services requiring prior authorization, please contact Utilization Review at 701-328-5990 or 888-777-5871.

Chiropractic Treatment includes additional information on requirements for chiropractic treatment.