Chiropractic insurance billing in Louisiana.

Original Medicare Part B covers medically necessary manual spinal manipulation to correct a subluxation (CPT 98940 to 98942). Use the AT modifier for active or corrective treatment; the modifier alone does not establish medical necessity.

For a usually covered service expected to be denied in a particular case, such as spinal manipulation that has become maintenance care, a valid ABN is required before treatment to transfer potential financial liability to the patient. Exams, X-rays and therapies performed by a chiropractor are statutorily excluded from this benefit; an ABN for those services is voluntary. Medicare Advantage uses separate plan coverage and notice procedures, not the Original Medicare ABN. See CMS guidance on advance notices and our chiropractic Medicare billing guide.

Original Medicare Part B claims in Louisiana are processed by Novitas Solutions (JH). Check its applicable Local Coverage Determination and documentation requirements for the date of service.

Carriers listed for Louisiana include Blue Cross and Blue Shield of Louisiana (and HMO Louisiana); UnitedHealthcare; Humana; Ambetter / Louisiana Healthcare Connections (Centene); AmeriHealth Caritas Louisiana; Aetna. Check the member’s product, network, claim destination and applicable chiropractic policy.

Chiropractic and physical-medicine benefits in Louisiana are frequently administered through delegated musculoskeletal / physical-health network managers, which changes WHERE claims, authorizations and treatment plans go. The two dominant managers nationally – and present in Louisiana – are:

• American Specialty Health (ASH / ASHLink), which administers chiropractic, acupuncture and PT networks for several large national carriers (historically Aetna, Cigna and various Anthem/Blue plans for chiropractic/acupuncture utilization management, claims, credentialing and visit authorizations routed through ASHLink rather than the health plan directly); and
• Optum Health / Optum Physical Health (the former ACN Group / OptumHealth Physical Health), which administers UnitedHealthcare’s chiropractic and outpatient-therapy network. Effective October 1, 2026, UnitedHealthcare’s Medicare Advantage reduction list removes prior authorization for spinal CMT 98940-98942. These removals are absent from the separate D-SNP list. Other therapy and commercial requirements remain specific to the member product and code; use the current UHC list and member portal. Blue Cross and Blue Shield of Louisiana (the largest in-state commercial payer) generally administers its OWN chiropractic/physical-medicine benefit under its Professional Provider Office Manual (Section 5.8) and iLinkBlue rather than delegating chiropractic to ASH. For Louisiana Medicaid, fee-for-service chiropractic is administered by LDH/Gainwell (hardcopy, Medical Review), while the Medicaid MCOs each handle adult chiropractic as an optional ‘In Lieu Of Services’ benefit. ALWAYS verify on the member’s card / via eligibility whether chiropractic is delegated to ASH or Optum (or carved out to the health plan) BEFORE sending the claim or authorization – misrouting is a top denial cause. (Delegation arrangements change by plan and year; confirm per member.)

What trips up chiropractic billing in Louisiana:

• Visit caps and benefit limits live in the member contract, not a single published policy – Blue Cross and Blue Shield of Louisiana’s manual expressly states the Member Contract/Certificate ‘may limit the number of days, visits or dollar amounts,’ and many plans aggregate chiropractic with PT/OT into a combined annual limit, so verify benefits per member before treating.
• Medical necessity / treatment-plan documentation is heavily enforced: BCBSLA requires skilled, reasonable and necessary care with a documented plan of care (diagnosis, long-term functional goals, frequency and duration), legible flow sheets and daily notes, and will recoup on audit; care that plateaus at maintenance level (no functional improvement) is not covered.
• Physical/occupational therapy re-evaluation timing: BCBSLA bundles those re-evaluation codes to therapy and does NOT allow that therapy re-eval until 3 months after the initial therapy evaluation (sooner only with a significant diagnosis change or a surgical procedure, on appeal with records).
• Modality / billing quirks: BCBSLA limits supervised modalities (97010-97028) to once per day regardless of areas, constant-attendance modalities (97032-97036) once per day, no duplicate heating modalities for the same area same day, and applies a steep multiple-procedure reduction (100/90/90/90/50/25/5% per unit) across CMT and therapy codes billed the same day; it also does NOT follow CMS ‘incident-to’ rules (each eligible provider must bill under his/her own number, and PTA services bill under the supervising PT).
• Modifier discipline: Original Medicare requires the AT modifier on active/corrective spinal manipulation (98940-98942), and Medicare covers ONLY spinal CMT by a DC (exams, x-rays and therapies billed by a chiropractor are statutorily excluded and need the appropriate Original Medicare exclusion modifier and voluntary notice); Effective October 1, 2026, UnitedHealthcare’s Medicare Advantage reduction list removes prior authorization for spinal CMT 98940-98942. These removals are absent from the separate D-SNP list. Other therapy and commercial requirements remain specific to the member product and code; use the current UHC list and member portal.
• Auth routing: when chiropractic is delegated to ASH or Optum, the treatment plan and visit authorizations must go to that vendor, not the health plan – a frequent ‘no authorization’ denial.
• Louisiana Medicaid is very restrictive for chiropractic: fee-for-service covers chiropractic manipulative treatment ONLY for beneficiaries under age 21 (via an EPSDT referral from the PCP), limited to manipulation of up to four spinal regions, billed HARDCOPY and pended to Medical Review with the signed referral and medical-necessity documentation; adults 21+ are not covered under fee-for-service and only obtain chiropractic where a Medicaid MCO elects to offer it as an ‘In Lieu Of Services’ benefit. (Plan-specific caps, criteria, delegation and Medicaid MCO benefits change yearly – verify per member/plan; this is general guidance, not legal advice.)

The member product and provider agreement set commercial initial-filing deadlines. R.S. 22:1833 generally requires electronic clean claims to be paid, denied or pended within 25 days. Under R.S. 22:1832, a contracted provider’s clean paper claim filed within 45 days of service or discharge has a 45-day processing clock; later-filed or resubmitted contracted paper claims have a 60-day clock.

Other covered paper claims generally use 45 days. R.S. 22:1834 permits an issuer to elect a uniform 30-day standard. These insurer processing periods do not establish the provider’s filing limit. Apply the product’s initial, corrected-claim, COB and appeal windows.

12 months (one calendar year) from the date of service. This is a federal limit under 42 CFR 424.44 / Section 1842(b)(3) of the Social Security Act and applies in Louisiana exactly as nationwide (Novitas Solutions is the Part B MAC for Louisiana, Jurisdiction H).

Claims filed after 12 months are denied (e.g., CO-29) absent a narrow CMS exception (administrative error, retroactive Medicare entitlement, Medicare Secondary Payer recoupment, or a declared disaster).

12 months (365 days) from the date of service for straight (fee-for-service) Louisiana Medicaid claims, per the Louisiana Medicaid ‘Timely Filing Guidelines.’ Key variations: for Medicare/Medicaid dual-eligible (crossover) claims, file with Medicare within 12 months and, if the claim fails to cross over, submit hardcopy to Medicaid within 6 months of the Medicare EOMB date; claims with third-party (other insurance) payment must reach Medicaid within 12 months of service.

Claims beyond two years require the current manual’s defined review criteria (retroactive Medicaid certification, a won Medicare/SSA appeal granting retroactive benefits, or state-caused repeated denials) with the required claim-specific evidence and a cover letter.

Certified-mail or delivery receipts alone are not accepted proof of timely filing. Louisiana Medicaid managed-care plans (Healthy Blue, AmeriHealth Caritas LA, Aetna Better Health, Humana Healthy Horizons, Louisiana Healthcare Connections) set their own filing limits by contract.

UnitedHealthcare left Healthy Louisiana effective April 1, 2026; use the member’s current plan.

Louisiana Workers’ Compensation does NOT impose a fixed number of days for a provider to SUBMIT a medical bill to the carrier/employer – neither La. R.S. 23:1201 nor the OWC medical-billing rules (LAC Title 40, Part I) set a hard provider-side timely-filing cutoff.

Practically, bills should be submitted promptly on the proper form (CMS-1500 / UB-04) with required documentation. The rules instead bind the CARRIER: under La. R.S. 23:1201 the carrier/employer generally has 60 days from receipt of the bill to pay or formally dispute it (Form LWC-WC-1008), and for a complete ELECTRONIC medical bill submitted under the e-billing rules (R.S. 23:1203.2) payment is due within 30 days; late/unpaid medical benefits expose the payer to penalties (up to the greater of 12% of the unpaid amount or $50/day) plus possible attorney fees.

Note: the injured worker’s overall WC CLAIM (not the medical bill) is subject to its own prescriptive periods under R.S. 23:1209. Confirm bill-submission expectations with the specific carrier/TPA.

Louisiana has NO fixed statutory deadline by which a provider must submit auto medical-payments (MedPay) or PIP bills, and Louisiana is a TORT (at-fault) state – it is NOT a no-fault/PIP state, and MedPay/PIP coverage is optional (not mandatory).

When a MedPay/auto policy exists, La. R.S. 22:1892 (former R.S. 22:1973 was repealed July 1, 2024) set the PAYER’s clock, not a provider filing cutoff: the insurer must pay the amount due within 30 days after receipt of satisfactory proof of loss, and an arbitrary/capricious failure exposes it to penalties (50% of the amount due or $1,000, whichever is greater, plus possible bad-faith damages).

Practical norm: bill the MedPay carrier promptly with records and an itemized bill; once MedPay is exhausted, the provider typically bills the patient’s health insurance (subject to that payer’s timely-filing window) or asserts a claim/medical lien against any third-party/liability recovery, which is governed by Louisiana’s personal-injury prescriptive period (now 2 years for delictual actions arising on or after July 1, 2024, per La.

C.C. art. 3493.1; 1 year for accidents before that date). Note Louisiana’s amended ‘No Pay, No Play’ rule (effective Aug. 1, 2025) can bar an uninsured motorist from recovering the first $100,000 of bodily-injury and property damages.