Louisiana Medicaid covers chiropractic care, but who qualifies depends on age. Beneficiaries under 21 are covered under the standard Medicaid State Plan through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program. Adults 21 and older are not covered under the traditional State Plan, but some Louisiana Medicaid managed care plans offer chiropractic care voluntarily as an “In Lieu of Services” benefit.
Coverage for Children and Young Adults Under 21
If the beneficiary is from birth through age 20, chiropractic manipulative treatment is a covered Medicaid benefit. The service is defined as manual manipulation of the spine by a licensed chiropractor, and reimbursement is limited to spinal manipulation of up to four regions per visit.1Louisiana Medicaid. Chiropractic Billing Information
A State Plan Amendment effective January 1, 2024, set the visit rules by age:
- Ages 5 through 20 may receive up to 12 dates of service per fiscal year without prior authorization, provided a licensed EPSDT medical screening provider has referred the child. Visits beyond 12 require both a referral and prior authorization.
- From birth through age 4, every date of service must be prior authorized by the fiscal intermediary before the first treatment.
These aren’t hard ceilings. The state applies the same medical necessity standard to every child regardless of age, and any service limitation for a beneficiary under 21 can be exceeded when additional care is medically necessary.2Medicaid.gov. Louisiana State Plan Amendment 24-0002
The Referral You’ll Need
Chiropractic services for anyone under 21 require a referral from the beneficiary’s EPSDT primary care physician before treatment. The referral must be written, signed, and dated, and it accompanies the claim when it is submitted.2Medicaid.gov. Louisiana State Plan Amendment 24-0002 Claims are submitted on paper and reviewed by Medical Review staff, and the chiropractor must document the diagnosis, chief complaint, history, exam findings, diagnostic test results, a treatment plan with the planned number of sessions, and progress notes.1Louisiana Medicaid. Chiropractic Billing Information
Coverage for Adults 21 and Older
Louisiana does not cover chiropractic services for adults in its standard fee-for-service Medicaid program. A 2018 Kaiser Family Foundation survey confirmed that Louisiana reported no chiropractic coverage for categorically needy adults under fee-for-service Medicaid.3KFF. Chiropractor Services – Medicaid Benefits
Starting in mid-2022, the Louisiana Department of Health authorized a chiropractic “In Lieu of Services” (ILOS) benefit for Medicaid managed care enrollees aged 21 and older.4Louisiana Healthcare Connections. Seeking Providers for New Medicaid Chiropractic In Lieu of Service Under federal regulation 42 CFR § 438.3(e)(2), an ILOS lets a managed care organization offer a medically appropriate, cost-effective substitute for services otherwise covered under the state plan. Louisiana’s chiropractic ILOS is aimed at adults with neuromusculoskeletal conditions, with stated goals of reducing opioid dependency and lowering pain-related emergency room visits.5Louisiana Department of Health. In Lieu of Services – Chiropractic Services Policy
How the Adult Benefit Works
Participating managed care plans cover up to 18 chiropractic treatment sessions per year without prior authorization. Sessions beyond 18 may still be covered, but the plan must authorize them. No referral from a primary care provider is required.6Louisiana Department of Health. MCO Manual – In Lieu of Services A treatment session counts as all chiropractic services performed on a single date.
Each visit can include spinal manipulation of up to five regions plus a maximum of two additional treatments such as mechanical traction, therapeutic exercises, massage therapy, electrical stimulation, ultrasound, or dry needling. X-rays are covered when needed to establish a diagnosis, but only the minimum number of views. Repeat imaging is not covered unless symptoms worsen or the clinical picture changes.7Humana. Chiropractic Services ILOS Policy
The initial visit must include a documented treatment plan covering the duration and frequency of care, treatment goals, and how the chiropractor will measure whether treatment is working. Follow-up visits must record the enrollee’s progress toward those goals.6Louisiana Department of Health. MCO Manual – In Lieu of Services
Which Plans Offer the Chiropractic Benefit
The ILOS is voluntary for each managed care organization, so not every Louisiana Medicaid plan covers chiropractic care for adults. Three plans have adopted the benefit:
- Humana Healthy Horizons, with a policy originally effective January 1, 2023, covering up to 18 sessions annually without prior authorization for members 21 and older with full benefits.7Humana. Chiropractic Services ILOS Policy
- Healthy Blue, effective August 1, 2022, under the same 18-session annual structure.8Healthy Blue. Chiropractic In-Lieu of Services
- AmeriHealth Caritas Louisiana, effective February 2023. This plan caps enrollment at 300 total enrollees per year for the chiropractic ILOS.9AmeriHealth Caritas Louisiana. Chiropractic Services for Adults – In Lieu Of
UnitedHealthcare Community Plan also has an approved chiropractic services policy on the Louisiana Department of Health’s managed care archive, with a comment period that closed in June 2025 and a status of “Approved.”10Louisiana Department of Health. Medicaid Managed Care Policies and Procedures Archive – 2025 Because participation is at each plan’s discretion and one plan has a member cap, call your MCO to confirm the benefit is currently available before scheduling.
What Louisiana Medicaid Will Not Cover
Coverage is limited to spinal manipulation. The State Plan Amendment defines chiropractic services as “manual manipulation of the spine,” and extraspinal manipulation, coded as CPT 98943, is not on the Louisiana Medicaid fee schedule and is not covered.11UnitedHealthcare. Manipulative Therapy – Louisiana Services that don’t meet the definition of medically necessary spinal manipulation fall outside the stated scope. Ancillary treatments like massage therapy, therapeutic exercises, and dry needling are covered only as part of the adult ILOS benefit through managed care, and not under the State Plan for children.
If You Have Both Medicare and Medicaid
For beneficiaries enrolled in both Medicare and Medicaid, Medicare pays first for chiropractic manipulation. Under Louisiana administrative code, Medicaid coverage for Medicare Part B crossover claims is limited to services also covered under Title XIX, and payment for coinsurance and deductibles is capped at the total Medicaid allowable cost for each covered service.12Cornell Law Institute. La. Admin. Code Tit. 50, § I-8303 Several of the MCOs offering the chiropractic ILOS also offer dual Medicare/Medicaid coverage, which can bring the out-of-pocket cost of a covered visit down to little or nothing.