Section 405 IAC 5-12-3 - Chiropractic x-ray servicesAuthority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2; IC 12-15-21-3
Affected: IC 12-13-7-3; IC 12-15; IC 25-10-1-1
Sec. 3.
Medicaid reimbursement is available for chiropractic x-ray services, subject to the following restrictions:
(1) Reimbursement is limited to one (1) series of full spine x-rays per member per year. Component x-rays of the series are individually reimbursable; however, if components are billed separately, total reimbursement is limited to the allowable amount for the series. Prior authorization is not required.(2) Reimbursement for localized spine series x-rays, and for x-rays of the joints or extremities, is allowable only when the x-rays are necessitated by a condition-related diagnosis. Prior authorization is not required.(3) Diagnostic radiological exams of the head and vascular system, as defined by the applicable procedure code, are not reimbursable.(4) Diagnostic ultrasound exams, as defined by the applicable procedure code, are not reimbursable.(5) X-rays that may be necessitated by the failure of another practitioner to forward, upon request, x-rays or related documentation to a chiropractic provider, are not reimbursable. Chiropractors are entitled to receive x-rays from other providers at no charge to the member upon a member's written request to the other providers and upon reasonable notice.Office ofthe Secretary of Family and Social Services; 405 IAC 5-12-3; filed Jul 25, 1997, 4:00p.m.: 20 IR 3314; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; filed May 1, 2003, 10:45 a.m.: 26 IR 2861; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFAFiled 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRAReadopted filed 7/28/2022, 2:21 p.m.: 20220824-IR-405220205RFAReadopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA