South Carolina Medicaid does cover chiropractic care, with a firm limit: up to six medically necessary visits per state fiscal year, which runs July 1 through June 30. The benefit is delivered through the state’s Medicaid managed care plans, so the specifics — copay, prior authorization, in-network providers — depend on which plan you’re enrolled in.
What’s Covered
Coverage focuses on the neuromusculoskeletal system: back pain, spinal misalignments, nerve pain, sprains and strains related to the spine, and functional mechanical disabilities of the spine. Humana Healthy Horizons describes the benefit as manual manipulation of the spine to correct a subluxation.1Humana. South Carolina Provider Manual 2024
Every visit has to be medically necessary. Wellness visits, posture work, and maintenance or preventive care aren’t covered — the chiropractor must be treating an identified condition.2Abundant Health Chiropractic. Medicaid Cover Chiropractic Care in SC
The Six-Visit Cap and X-Rays
Six visits per state fiscal year is the core limit, and it applies across the major managed care plans. Absolute Total Care lists the cap as one visit per day and six per year.3Absolute Total Care. Copays Humana Healthy Horizons uses the same annual cap.1Humana. South Carolina Provider Manual 2024
Medicaid also covers up to two X-ray examinations per beneficiary per state fiscal year when the chiropractor determines they’re needed for diagnosis and treatment planning.2Abundant Health Chiropractic. Medicaid Cover Chiropractic Care in SC
Costs, Referrals, and Prior Authorization
Copays vary by plan and can be nothing at all. Absolute Total Care’s schedule lists a $0 copay for chiropractic services as of July 2024.3Absolute Total Care. Copays Other plans may charge a small copay, so confirm with your MCO before your first visit.
You generally don’t need a primary care referral. Absolute Total Care says members don’t need a paper referral to see a provider,3Absolute Total Care. Copays and the SCDHHS Physicians Services Provider Manual doesn’t list one for chiropractic care.4SC Department of Health and Human Services. Physicians Services Provider Manual Some plans may still require one in specific situations, so it’s worth asking.
Prior authorization depends on the plan and sometimes on the patient’s age. Select Health of South Carolina’s prior authorization grid, revised in January 2026, requires prior authorization for chiropractic care for patients under 18.5Select Health of South Carolina. Prior Authorization Grid Healthy Blue requires prior authorization for chiropractic services above standard limits.6Healthy Blue SC. Provider Administrative Office Manual The chiropractor’s office usually handles the paperwork, but ask before you book.
Children Under 21 Can Get More Than Six Visits
If the patient is under 21, the six-visit cap isn’t necessarily the end of the road. Under EPSDT (Early and Periodic Screening, Diagnostic and Treatment), state Medicaid programs must cover medically necessary services for children and can’t apply the same visit caps or dollar limits that apply to adult benefits.7Disability Rights SC. Medicaid for Children: Early and Periodic Screening, Diagnosis, and Treatment
If a provider documents that additional chiropractic treatment is medically necessary to correct or improve a condition found during screening, EPSDT should cover it past the annual cap. Prior authorization is typically required for EPSDT treatment services.8SC Department of Health and Human Services. EPSDT If a request is denied, the family has 30 days to submit a written appeal to the SCDHHS Division of Appeals and Hearings.7Disability Rights SC. Medicaid for Children: Early and Periodic Screening, Diagnosis, and Treatment
Finding a Chiropractor Who Takes Medicaid
Not every chiropractor in the state accepts Medicaid. To treat Medicaid patients, a chiropractor has to be licensed by the South Carolina Board of Chiropractic Examiners and enrolled with Medicaid with a valid Medicaid ID number.4SC Department of Health and Human Services. Physicians Services Provider Manual A few ways to find one:
- The SCDHHS provider search lets you filter by “Chiropractor Group” or “Chiropractor Individual” and by county.9SC Department of Health and Human Services. Search for SC Medicaid Providers
- Each managed care plan runs its own directory. Absolute Total Care members can search at absolutetotalcare.com or call 1-866-433-6041. Healthy Blue members can search at healthybluesc.com or call 866-781-5094.10Absolute Total Care. Find a Provider11Healthy Blue SC. Find a Doctor
- Calling the member services number on the back of your Medicaid card is the fastest way to confirm a specific chiropractor is in-network and to check how many of your six visits are left this year.
South Carolina routes most of its Medicaid population through managed care, and the major MCOs — Absolute Total Care, Healthy Blue, Select Health (First Choice), and Humana Healthy Horizons — all include chiropractic as a covered benefit within the six-visit annual limit. If you’re not sure which plan you’re in, call SCDHHS or the number on your card.