Where this LCD applies
Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.
| Contract | Contractor | Type | States |
|---|---|---|---|
| 11202 | Palmetto GBA | A and B and HHH MAC | SC |
| 11302 | Palmetto GBA | A and B and HHH MAC | VA |
| 11402 | Palmetto GBA | A and B and HHH MAC | WV |
| 11502 | Palmetto GBA | A and B and HHH MAC | NC |
| 10112 | Palmetto GBA | A and B MAC | AL |
| 10212 | Palmetto GBA | A and B MAC | GA |
| 10312 | Palmetto GBA | A and B MAC | TN |
Billing and coding: diagnoses and procedure codes
Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A56616 (Billing and Coding: Chiropractic Services) carries the diagnosis and procedure lists the contractor loads as the claims edit. CPT codes are shown as bare numbers because the descriptors are licensed by the AMA; HCPCS Level II descriptors are public and shown.
A56616: Billing and Coding: Chiropractic Services (Billing and Coding, effective 2024-12-19)
- Covered ICD-10-CM codes
- 5
- 1 group
- Non-covered ICD-10-CM codes
- 0
- Procedure codes listed
- 3
- Full article
- cms.gov record
| ICD-10-CM | Description (FY2027) |
|---|---|
| M99.01 | — |
| M99.02 | — |
| M99.03 | — |
| M99.04 | — |
| M99.05 | — |
Procedure codes: 98940, 98941, 98942.
Coverage indications, limitations and medical necessity
Chiropractic manipulative treatment (CMT) is a form of manual treatment to influence joint and neurophysiological function. This treatment may be accomplished using a variety of techniques. Medicare covers limited chiropractic services when carried out by a chiropractor who is legally authorized or licensed to provide chiropractic services by the State or jurisdiction in which the services are provided. A chiropractor must also meet uniform minimum standards as set forth in the Centers for Medicare and Medicaid Services (CMS) Internet-Only Manual (IOM). This policy restates language directly from the CMS IOMs and if necessary provides clarification to educate providers on specified Medicare requirements for the diagnosis, treatment, documentation and billing of chiropractic services.
Indications
Chiropractic Services – Active Treatment:
The patient must have a significant health problem in the form of a neuromusculoskeletal condition necessitating treatment and the manipulative services rendered must have a direct therapeutic relationship to the patient’s condition and provide reasonable expectation of recovery or improvement of function. The patient must have a subluxation of the spine as demonstrated by x-ray or physical exam.
Most spinal joint problems fall into the following categories:
• Acute subluxation - A patient’s condition is considered acute when the patient is being treated for a new injury identified by x-ray or physical exam as specified above. The result of chiropractic manipulation is expected to be an improvement in or arrest of progression of the patient’s condition.
• Chronic subluxation - A patient’s condition is considered chronic when it is not expected to significantly improve or be resolved with further treatment (as is the case with an acute condition) but where the continued therapy can be expected to result in some functional improvement. Once the clinical status has remained stable for a given condition, without expectation of additional objective clinical improvements, further manipulative treatment is considered maintenance therapy and is not covered.
An acute exacerbation is a temporary but marked deterioration of the patient’s condition that is causing significant interference with activities of daily living (ADLs) due to an acute flare-up of the previously treated condition. The patient’s clinical record must specify the date of occurrence, nature of the onset or other pertinent factors that would support the medical necessity of treatment. As with an acute injury, treatment should result in improvement or arrest of the deterioration within a reasonable period of time.
A. Maintenance Therapy
Maintenance therapy includes services that attempt to avert disease, facilitate health and extend and improve the quality of life; or therapy that is implemented to preserve or avoid deterioration of a chronic condition. The treatment is considered maintenance therapy when additional clinical advancement cannot logically be expected from constant ongoing care and the chiropractic treatment becomes auxiliary rather than curative in nature.
B. Contraindications
Dynamic thrust is the therapeutic force or maneuver delivered by the physician during manipulation in the anatomic region of involvement. A relative contraindication is a condition that adds significant risk of injury to the patient from dynamic thrust but does not rule out the use of dynamic thrust. The doctor should discuss this risk with the patient and record this in the chart.
The following are relative contraindications to dynamic thrust:
• Articular hypermobility and circumstances where the stability of the joint is uncertain,
• Severe demineralization of bone,
• Benign bone tumors (spine),
• Bleeding disorders and anticoagulant therapy, and
• Radiculopathy with progressive neurological signs.
Dynamic thrust is absolutely contraindicated near the site of demonstrated subluxation and proposed manipulation in the following:
• Acute arthropathies characterized by acute inflammation and ligamentous laxity and anatomic subluxation or dislocation, including acute rheumatoid arthritis and ankylosing spondylitis,
• Acute fractures and dislocations or healed fractures and dislocations with signs of instability,
• An unstable os odontoideum,
• Malignancies that involve the vertebral column,
• Infection of bones or joints of the vertebral column,
• Signs and symptoms of myelopathy or cauda equina syndrome,
• For cervical spinal manipulations, vertebrobasilar insufficiency syndrome, and
• A significant major artery aneurysm near the proposed manipulation.
Limitations:
Coverage of chiropractic service is specifically limited to treatment by means of manual manipulation, i.e., by use of the hands. Additionally, manual devices (i.e., those that are hand-held with the thrust of the force of the device being controlled manually) may be used by chiropractors in performing manual manipulation of the spine. However, no additional payment is available for use of the device nor does Medicare recognize an extra charge for the device itself.
No other diagnostic or therapeutic service furnished by a chiropractor or under the chiropractor’s order is covered. This means that if a chiropractor orders, takes or interprets an x-ray or any other diagnostic test, the x-ray or other diagnostic test can be used for claims processing purposes but Medicare coverage and payment are not available for those services. This prohibition does not affect the coverage of x-rays or other diagnostic tests furnished by other practitioners under the program. For example, an x-ray or any diagnostic test taken for the purpose of determining or demonstrating the existence of a subluxation of the spine is a diagnostic x-ray test covered under §1861(s)(3) of the Social Security Act if ordered, taken and interpreted by a physician who is a doctor of medicine or osteopathy.
The specified qualifying requirements for the term "physician", which includes a chiropractor, and the coverage extensions to treat by means of manual manipulation of the spine to correct a subluxation are set forth in the CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §30.5 Physician Services-Chiropractor's Services.
The mere statement or diagnosis of "pain" is not sufficient to support medical necessity for the treatments. The precise level(s) of the subluxation(s) must be specified by the chiropractor to substantiate a claim for manipulation of each spinal region(s). There are 5 spinal regions addressed by this local coverage determination (LCD): cervical region (atlanto-occipital joint), thoracic region (costovertebral/costotransverse joints), lumbar region, pelvic region (sacro-iliac joint) and sacral region.
Medicare does not cover chiropractic treatments to extraspinal regions. The 5 extraspinal regions are: head (including temporomandibular joint, excluding atlanto-occipital) region, lower extremities, upper extremities, rib cage (excluding costotransverse and costovertebral joints) and abdomen.
The need for a prolonged course of treatment should be appropriate to medical necessity and must be documented clearly in the medical record.
Summary of evidence (opening)
N/A
the full summary and analysis of evidence are in the CMS record.
Dates, lineage and related policies
- Original determination effective
- 2017-09-25
- Current revision effective
- 2024-12-19
- Last reviewed by the contractor
- 2024-11-12
- MCD version
- 25
Using this policy on a claim
Match the documented indication to the covered indications above before the service is scheduled, carry a diagnosis from the article's covered list on the claim line, and keep the elements the documentation section asks for in the record, because the contractor can request it later through medical review. A denial under this policy arrives as CARC 50 with remark N115; the LCD lookup guide walks through the appeal path and the Advance Beneficiary Notice rules, and the Palmetto GBA hub lists every other active policy from the same contractor.
The same policy title at other contractors
Contractors often adopt each other's policies and then revise them separately, so the criteria and the diagnosis lists drift apart. The topic comparison lines up every version.
Frequently asked questions
What does LCD L37387 cover?
Chiropractic manipulative treatment (CMT) is a form of manual treatment to influence joint and neurophysiological function. This treatment may be accomplished using a variety of techniques. Medicare covers limited chiropractic services when carried out by a chiropractor who is legally authorized or licensed to provide chiropractic services by the State or jurisdiction in which the services are provided. A… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database export of September 24, 2026.
Which states does LCD L37387 apply to?
Palmetto GBA applies it to Medicare claims in AL, GA, NC, SC, TN, VA, WV. A Local Coverage Determination binds only the contractor that wrote it; the same service in another jurisdiction is judged under that contractor's own policy or, where none exists, claim by claim.
Which diagnosis codes support medical necessity under LCD L37387?
The companion billing and coding article A56616 lists 5 ICD-10-CM codes in 1 group that support medical necessity; the first 5 appear on this page and the complete list is in the article on cms.gov.
How do I appeal a denial under LCD L37387?
The remittance carries claim adjustment reason code 50 with remark code N115, naming the LCD. Compare the documented indication with the policy's covered indications and the article's diagnosis list, then file a redetermination within 120 days with the record attached; if the service genuinely falls outside the policy, the patient can be billed only when a valid Advance Beneficiary Notice was obtained before the service.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file lcd.csvSHA-256 2fcc4251b6ddd1eb…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file article.csvSHA-256 f31932f1df3b4035…
- ICD-10-CM FY2027 code descriptionsVersion FY2027 · effective 2026-10-01 · file icd10cm_codes_2027.txtSHA-256 3c0583a38ee0e848…
Disclaimer
The policy text and code lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify against the current LCD and article on cms.gov before billing; coverage depends on the full record and the contractor. Not legal, clinical or billing advice.