Blue Cross Blue Shield’s Clinical Policy Guidelines For Chiropractic Services
Is Chiropractic Care Covered?
Yes. Coverage varies greatly by state. BCBS may have multiple local plans per state. Typically charges are submitted to the local Blue Cross Blue Shield Association individual licensee (eg. Highmark, Empire, Anthem, etc.). While all are part of the BCBS Association, each plan may have a wide variety of coverage allowances and utilization rules/requirements.
Does Chiropractic Care Need Pre-Authorization?
Yes. Requirements vary by state.
For example, in western Pennsylvania, Highmark Blue Cross Blue Shield implemented a Physical Medicine Management Program (PMMP) that requires chiropractors to submit specific documentation for pre-authorization before patients can receive care. Chiropractors are tiered based on their strict adherence to these guidelines.
Chiropractors’ patients may be subject to higher copays and lesser visit allowances for their practitioners not adhering to the policies. Physicians are reviewed for performance and scored yearly. Chiropractors’ ratings improve by using fewer visits and fewer procedures during a patient’s course of care.
Is A Third Party Company Used To Manage Chiropractic Benefits?
No.
Physical Medicine Management Program (PMMP) dictates benefit utilization.
Are There Limits To Chiropractic Coverage?
Yes.
Limits are based on medical necessity guidelines. More stringent restrictions are imposed when a Physical Medicine Management Program (PMMP) has been instituted.
View Blue Cross Blue Shield’s Chiropractic Policies Here…
Physician Review
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