Medicare Chiropractic Services Form
Procedure is not covered
For medical necessity clinical coverage criteria, relative contraindications, and treatment parameters, refer first to the Medicare Benefit Policy Coverage Manual, Chapter 15, Medicare Benefit Policy Manual (cms.gov) and any relevant Local Coverage Determinations (LCDs), followed by InterQual® LOC Outpatient Rehabilitation and Chiropractic InterQual® (cue4.com).
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