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Good Evening
7:55:30 PM CDT
Friday, February 27, 2015

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Chiropractic

Prior authorization guidelines are applicable for all chiropractic services, including referrals. Physician referral does not waive prior authorization requirements.

Each claim has one window period for chiropractic treatment, which encompasses all body parts accepted on a claim. Changing chiropractors during the course of treatment does not start a new window period.

Chiropractic Window Period
  • 12 visits or 90 days of care, whichever comes first
  • Modalities are limited to two per visit
  • Prior Authorization is required for treatment extending beyond the window period
Submitting a Prior Authorization Request for Chiropractic Services
Submitting a Prior Authorization Request for Palliative Care

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

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