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 | Office Visit:
| 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: Follow up Office Visit or Home Visit: | up to a maximum payment of $70, limited to one x-ray per calendar year |
| 00Y | Office Visit: Chiropractic Manipulation: | Up to $75 per calendar year for x-ray films of the spine |
*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
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform |