Family and Children's Medicaid MA-3540 Medicaid Covered Services
Refer to DMA’s website at http://www.dhhs.state.nc.us/dma/mp/mpindex.htm for specific coverage criteria, prior approval requirements, and service limitations.
A. Covered Services
1. Manual manipulation of the spine to correct a subluxation
2. X-rays to document the condition for which manual manipulation of the spine is appropriate
B. Non-Covered Services
1. Office visits
2. Nutritional supplements
3. Physical therapy
4. Any other diagnostic or therapeutic service
NOTE: Relative to all services listed above and for recipients under the age of 21 in regard to EPSDT requirements, see I. and XXXVIII. of this manual section.
1. The subluxation must be supported by an x-ray dated within six months of the date of service and an appropriate diagnosis.
2. Office visits count toward a recipient’s professional services visit limit except as noted in II.A.
3. Prior approval is required for MPW recipients.
1. $2.00 per visit
2. Copayments apply to all Medicaid recipients except as noted in II.E.
REVISED 08/01/11 – CHANGE NO. 14-11