1. (a) To be eligible for payment under 7 AAC 105 - 7 AAC 160 for providing chiropractic services, a chiropractor must

   1. (1) be enrolled as a chiropractor in accordance with 7 AAC 105.210;
   2. (2) have an active license to practice chiropractic issued by the jurisdiction in which the chiropractor provides services; if services are provided in this state, the individual must hold an active license under AS 08.20.

2. (b) To be eligible for payment under 7 AAC 105 - 7 AAC 160 for providing chiropractic services in a group practice, the group must

   1. (1) be enrolled in accordance with 7 AAC 105.210; and
   2. (2) be comprised of one or more individuals who meet the requirements of (a) of this section.
3. (c) The department will only pay for chiropractic services identified in the CPT Fee Schedule for Chiropractic Services table adopted by reference in 7 AAC 160.900. Subject to the limitations in (d) of this section, the department will pay for manual manipulation to correct a subluxation of the spine, and x-rays necessary for diagnosis, if the subluxation of the spine resulted in a neuromusculoskeletal condition for which manual manipulation is the appropriate treatment. If there is no x-ray to support that a subluxation exists, the recipient's record must contain complete documentation of the examination results justifying manual manipulation for subluxation of the spine.

4. (d) Except as provided in 7 AAC 110.200(3), the department will not pay for the following chiropractic services:

   1. (1) chiropractic services for an individual 21 years of age or older, unless the individual is a Medicare recipient;
   2. (2) more than 12 visits to a chiropractor by a recipient in a calendar year;
   3. (3) x-rays, except for a diagnostic x-ray of the specific area of the spine requiring treatment;
   4. (4) more than one x-ray billing code during a calendar year for a recipient;
   5. (5) chiropractic services for a child under six years of age, unless the department has given prior authorization for the service and the service is supported by a referral from a physician, advanced nurse practitioner, or physician assistant;
   6. (6) a chiropractic service for which the department has not established a payment rate under 7 AAC 145.110.
5. (e) A chiropractor must maintain in the chiropractor's place of business a recipient medical record, either written or electronic, containing complete documentation of the examination results justifying manual manipulation for subluxation of the spine when there is no supporting x-ray.
6. (f) In this section, "subluxation" has the meaning given "subluxation complex" in AS 08.20.900.

(Eff. 2/1/2010, Register 193; am 5/1/2016, Register 218)

Authority: AS 47.05.010, AS 47.07.030, AS 47.07.040