Benefits for these services are subject to the following guidelines:
20 visits will be allowed per calendar year without certification. A maximum of
60 visits will be allowed each calendar year.
Treatments, which exceed 20 visits per calendar year, must be referred to Health
Care Management Division (HCMD) and the appropriate professional consultant for
review. Manipulative therapy performed by an osteopath or medical doctor is also
subject to these guidelines.
Referral forms for chiropractic, physical medicine, occupational therapy and physical
therapy must be completed and submitted to HCMD to initiate the certification process.
The professional consultant could subsequently request additional documentation from
the provider.
The following information will be requested on the referral form:
The following information may be requested by the professional consultant to support medical necessity:
