Decorative arrowsHMSA Provider Resource Center
HomeNews and AlertsE-LibraryMedicare E-LibraryCommunications ArchiveQUEST Integration
Frequently Asked QuestionsUseful Web SitesContacting HMSA
HMSA Logo
 

Chiropractic Riders: Procedure Codes, Coverage Codes and Benefits

 

This page refers to chiropractic riders administered by HMSA.  For Complimentary Care riders administered by American Specialty Health [ASH], please contact ASH at 1-800-972.4226. Providers who participate with ASH may also obtain information online at ashlink.com.

 

 

Coverage codes and benefits for HMSA Chiropractic Riders

 

Chiropractic Rider Coverage Code

Office Visit Benefit

X-Ray Film  Benefit

00A

$10 per visit for up to 12 office visits per calendar year

50% of eligible charges for x-ray films of the spine only, up to a maximum payment of $50 per calendar year.

00E

$20 per visit for up to 20 office visits per calendar year

90% of eligible charges for x-ray films of the spine only, up to a maximum payment of $50 per calendar year.

00F

$10 per visit for up to 12 office visits per calendar year

80% of eligible charges for x-ray films of the spine only, up to a maximum payment of $50 per calendar year.

00G

$20 per visit for up to 20 office visits per calendar year

100% of eligible charges for x-ray films of the spine only, up to a maximum payment of $50 per calendar year.

00H

$20 per visit for up to 12 office visits per calendar year

50% of eligible charges for x-ray films of the spine only, up to a maximum payment of $75 per calendar year.

00L

$20 per visit for up to 20 office visits per calendar year

50% of eligible charges for x-ray films of the spine only, up to a maximum payment of $50 per calendar year.

00T

First Office Visit:  

Up to a maximum $36 for the first office visit, limited to on per calendar year.

 

Follow up Office Visit or Home Visit:  

Up to a maximum payment of $31 for follow up office visits, and up to a maximum payment of $36 for home visits, limited to a maximum of nine combined follow up office and home visits per calendar year.

up to a maximum payment of $70, limited to one x-ray per calendar year

00Y

Office Visit:  

Up to $60 for one visit per calendar year.


Chiropractic Manipulation:  

Up to $45 per manipulation for up to 20 manipulations per calendar year.
 Modalities are NOT covered.

90% of eligible charges for x-ray films of the spine only, up to a maximum payment of $50 per calendar year.

 

*Member will owe the entire charge and HMSA reimburses the member.

*To be eligible for payment, chiropractic services must be necessary for the diagnosis and treatment of an injury or illness of the back or spine

 

 

The following are procedure codes recognized by HMSA Chiropractic Riders:

Office Visits

New Patient

 

99201 - 99205

 

Office or other outpatient visit for the evaluation and management of a new patient

 

 

Established Patient

 

99211 - 99215

 

Office or other outpatient visit for the evaluation and management of an established patient

 

 

Home Visits (only for coverage code 00T)

New Patient

 

99341 – 99345

 

Home visit for the evaluation and management of a new patient

 

 

Established Patient

 

99347 – 99350

 

Home Visit for the evaluation and management of an established patient

 

 

Chiropractic Manipulative Treatment

 

98940 - Chiropractic manipulative treatment (CMT); spinal, one to two regions

 

98941 - spinal, three to four regions

 

98942 - spinal, five regions

 

98943 - extraspinal, one or more regions

 

 

X-Ray Films

 

72020 - Radiologic examination, spine, single view, specify level

 

72040 - Radiologic examination, spine, cervical; two or three views

 

72050 - Radiologic examination, spine, cervical; four or five views

 

72052 - Radiologic examination, spine, cervical; six or more views

 

72070 - Radiologic examination, spine; thoracic, two views

 

72072 - Radiologic examination, spine; thoracic, three views

 

72074 - Radiologic examination, spine; thoracic, minimum of four views

 

72080 - Radiologic examination, spine; thoracolumbar junction, minimum two views

 

72081 - Radiologic examination, spine; entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); one view

 

72082 - Radiologic examination, spine; entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); two or three views

 

72083 - Radiologic examination, spine; entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); four or five views

 

72084 - Radiologic examination, spine; entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); minimum of 6 views

 

72100 - Radiologic examination, spine, lumbosacral; two or three views

 

72110 - Radiologic examination, spine, lumbosacral; minimum of four views

 

72114 - Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views

 

72120 - Radiologic examination, spine, lumbosacral, bending views only, two or three views

 

72170 - Radiologic examination, pelvis; one or two views

 

72190 - Radiologic examination, pelvis; complete, minimum of three views 

 

72200 - Radiologic examination, sacroiliac joints; less than three views

 

72202 - Radiologic examination, sacroiliac joints; three or more views

 

72220  Radiologic examination, sacrum and coccyx; minimum of two views

 

 

 

 

BCIS: May 2019
 

 

 

Latest Revision:05/02/2019
Back to Top

Files that are in PDF format can be viewed using the free Adobe Reader or another PDF-reader application.

Decorative arrowsHomeNews and AlertsE-LibraryMedicare E-LibraryCommunications ArchiveQUEST IntegrationFrequently Asked QuestionsUseful Web SitesContacting HMSA

Non-discrimination notice

Need a language interpreter?

ʻŌlelo Hawaiʻi | Bisaya | 繁體中文 | Ilokano | 日本語 | 한국어 | ພາສາລາວ | Kajin Ṃajōḷ | Lokaiahn Pohnpei | Gagana Sāmoa | Español | Tagalog | Tonga | Foosun Chuuk | Tiếng Việt