Chiropractic insurance billing in Michigan.

Medicare’s chiropractic rules are federal — the same in every state. Medicare Part B covers ONLY manual manipulation of the spine to correct a subluxation (CPT 98940–98942), and ONLY when the care is active or corrective — which you signal with the AT modifier. Maintenance care, exams, X-rays, and any therapies performed by a chiropractor are not covered, so a properly executed ABN is essential before non-covered services. The full federal rules are in our chiropractic Medicare billing guide.

Part B claims in Michigan are processed by WPS Government Health Administrators (J8) — its Local Coverage Determination and documentation expectations (and its audits of the AT modifier and medical necessity) are the ones your Michigan claims are measured against.

A Michigan chiropractic or multi-specialty practice spends most of its commercial billing day with: Blue Cross Blue Shield of Michigan; Priority Health (Corewell Health); UnitedHealthcare; Meridian Health Plan (Centene); Aetna; Molina Healthcare.

Each has its own claim portal, fee schedule, and chiropractic medical-policy quirks.

Michigan’s chiropractic/physical-medicine utilization is largely managed through delegated/utilization-management vendors, which changes WHERE prior authorizations and (sometimes) claims route. The managers that matter in Michigan:

• eviCore by Evernorth (a Cigna/Evernorth company) — this is the dominant delegated physical-medicine manager for the state’s largest payer: Blue Cross Blue Shield of Michigan and Blue Care Network (BCN) contract with eviCore to review chiropractic/physical-medicine prior authorizations. For BCN (commercial and BCN Advantage), chiropractic spinal-manipulation care requires prior authorization, and physical, occupational, speech therapy and chiropractor-performed physical-medicine services are reviewed by eviCore; the initial evaluation has been exempt from authorization since 5/27/2019, but the treatment plan/follow-up visits must be authorized via eviCore (provider portal evicore.com or BCN e-referral).
• Optum Physical Health (a UnitedHealth Group company) — manages UnitedHealthcare’s chiropractic/physical-health utilization. UHC/Optum imposed prior authorization on Medicare Advantage chiropractic (AT-modifier spinal manipulation) effective 9/1/2024, with an exemption for the first 6 visits within 8 weeks (for new patients, new conditions, or a 90+ day gap in care) before medical-necessity review kicks in. IMPORTANT CURRENT DEVELOPMENT: in 2026 UnitedHealthcare announced it is ELIMINATING prior authorization for chiropractic care (as part of removing PA on ~30% of services) before the end of 2026 — so the UHC/Optum chiropractic PA requirement is being rolled back; verify current status on UHCprovider.com before relying on it.
• American Specialty Health (ASH / ashlink.com) — the national chiropractic/PT/acupuncture network manager that administers chiropractic for Cigna in many states (claims/auth route to ASHLink, not the health plan). NOTE: Michigan was NOT on Cigna’s 2023 ASH market-expansion list, so do NOT assume Cigna chiropractic in Michigan is carved out to ASH — verify ASH delegation per member/plan before routing a claim or auth to ASHLink. ALWAYS check the member’s card/portal to confirm whether chiropractic/physical-medicine is managed by eviCore (BCBSM/BCN), Optum (UHC), ASH (some Cigna), or the plan directly before submitting — misrouting a delegated auth/claim is a leading Michigan denial cause.

What actually trips up chiropractic billing in Michigan:

• BCBSM/BCN prior auth via eviCore — BCN (commercial AND BCN Advantage) requires prior authorization for chiropractic spinal manipulation, routed through eviCore/BCN e-referral; the initial evaluation is exempt (since 5/27/2019) but follow-up/treatment visits need an authorized treatment plan — failing to obtain the eviCore auth after the initial eval is a top denial. BCN coverage for established-patient chiropractic E/M is generally limited (e.g., roughly once every 12 months per chiropractor on some products), and NO BCBSM/BCN policy covers maintenance care — the active-treatment vs. maintenance distinction is strictly enforced.
• Maintenance care never covered — across Michigan payers (BCBSM/BCN, Medicare, Medicaid), only active/corrective treatment toward functional improvement is payable; maintenance/wellness manipulation is non-covered, so documentation must show medical necessity and progress.
• E/M same-day bundling + modifier -25 — CMT codes (98940-98943) include a brief pre-manipulation assessment, so a same-day office/outpatient E/M (99202-99215) is bundled unless it is separately identifiable (new patient, new injury/condition, exacerbation, periodic re-evaluation); use modifier -25 appropriately or expect the E/M to bundle/deny.
• Medicare/MA modifiers — spinal CMT to Medicare/MA requires the AT modifier for active treatment, correct GA/GY/GZ usage, and the understanding that ONLY manual spinal manipulation (98940-98942) is covered (exams/x-rays/therapies by a DC are non-covered to Part B). UHC/Optum MA required chiropractic prior auth from 9/1/2024 (6 visits/8 weeks exempt) but is eliminating that PA before end of 2026 — track the change.
• No-fault auto (PIP) is a major Michigan chiropractic revenue source but high-risk — bill within 1 year of each date of service (one-year-back rule, MCL 500.3145); since the 2019 no-fault reform, watch the patient’s PIP coverage tier/cap and whether medical is coordinated (health insurance primary) vs. uncoordinated, and note the fee schedule that now caps provider reimbursement for auto-injury care.
• Workers’ comp — bill on CMS-1500 within 1 year (R 418 rules) and expect payment to follow the WC fee schedule and depend on claim compensability.
• Clean-claim/prompt-pay leverage — on commercial/HMO/Blue Cross claims, MCL 500.2006 entitles you to payment within 45 days and 12% interest on late clean claims (does NOT apply to auto, WC, Medicaid, Medicare, or self-funded plans). Verify benefits, delegation, and current rules per payer. Not legal advice.

Largely contract/payer-set, BUT Michigan is unusual in having a STATUTORY one-year billing floor baked into its clean-claim law: under MCL 500.2006, a health professional or facility must bill the health plan within 1 YEAR after the date of service (or date of discharge) for the claim to qualify as a ‘clean claim’ — so 12 months is effectively the outer statutory limit for commercial/HMO/Blue Cross claims in Michigan.

Individual payer contracts routinely impose SHORTER deadlines: Blue Cross Blue Shield of Michigan / Blue Care Network (by far the dominant MI commercial payer) commonly requires filing within 180 days of the date of service per its provider manual, and other commercial payers typically run 90-180 days for in-network — always confirm the exact window in your participating-provider agreement.

Michigan prompt-pay/clean-claim context (how fast the PLAN must pay YOU, not your submission deadline): under MCL 500.2006, a clean claim must be paid within 45 days of receipt; the plan must notify the provider of any defect (non-clean status) within 30 days of receipt; and 12% annual interest accrues on amounts not paid within 45 days.

NOTE: MCL 500.2006’s clean-claim/prompt-pay regime expressly does NOT apply to no-fault auto, workers’ comp, Medicaid, Medicare/Medicare Advantage, pharmacy, or self-funded (ERISA) plans. As of 2025-2026; verify per payer and contract.

Federal limit: generally 12 months (one calendar year) from the date of service to submit an initial Medicare fee-for-service (Part B) claim. Set by the Social Security Act (1842(b)(3)) and CMS, not by Michigan. Medicare Advantage plans set their own deadlines (often similar, up to ~12 months, though some MA/commercial-administered plans use 180 days) — confirm per plan.

Reminder for chiropractic: Medicare Part B covers ONLY manual manipulation of the spine to correct a subluxation (CPT 98940-98942) with the AT modifier for active treatment; exams, x-rays, and therapies by a DC are statutorily non-covered.

Michigan Medicaid (MDHHS — Michigan Department of Health and Human Services): the timely-filing limit is 12 MONTHS (1 year) from the date of service, per the MDHHS Medicaid Provider Manual and the MDHHS ‘Timely Filing’ policy (this 12-month standard was set by bulletin MSA 16-37, effective January 1, 2017, which shortened the prior limit).

Claims over one year old are considered ONLY if the late filing is due to a documented policy exception (e.g., retroactive beneficiary eligibility, retroactive provider enrollment, Medicare/other-insurance (TPL) coordination, court/hearing decisions) — the provider must request the exception through the local MDHHS office and, once approved, note ‘MSA-1038 on file’ (the approved Timely Filing exception form) in the claim comments.

Michigan Medicaid MANAGED-CARE plans (Medicaid Health Plans / Comprehensive Health Care Program MCOs — e.g., Meridian Health Plan of Michigan, Molina Healthcare of Michigan, Blue Cross Complete, McLaren, Priority Health Choice, UnitedHealthcare Community Plan) set their own timely-filing windows in their provider agreements — commonly 180 days to 1 year — so confirm with the specific MCO.

Michigan Workers’ Compensation: a provider must bill the carrier within 1 YEAR of the date of service to be considered for payment. This is set by the Michigan Workers’ Compensation Health Care Services Rules (Mich. Admin. Code R 418.10101 et seq., administered by the Workers’ Disability Compensation Agency under LEO) — the claim-filing-limitation rule requires the provider to submit bills within one year of the date of service, with limited exceptions (e.g., cases in litigation or subrogation).

Bills are submitted on the CMS-1500 (HCFA) form per the Health Care Services Rules. On the PAYER side, carriers generally process/pay bills within ~30 days, but payment ultimately depends on the compensability of the underlying WC claim (an accepted/established injury).

PRACTICAL norm: submit promptly and within 1 year; confirm each carrier/TPA’s e-billing instructions. Not legal advice.

Michigan is a NO-FAULT state with mandatory PIP (Personal Injury Protection) medical benefits. There is a hard, well-known deadline: under MCL 500.3145, the ‘one-year-back rule’ bars recovery of any PIP medical expense incurred MORE THAN ONE YEAR before the date a claim/lawsuit for that expense is filed — so practically, each medical bill must be submitted to the auto insurer within ONE YEAR of the date the expense was incurred (each date of service starts its own rolling one-year clock), or that bill becomes uncollectible from the no-fault carrier.

Separately, MCL 500.3145 also requires that an action for PIP benefits be commenced within 1 year of the accident UNLESS, within that first year, written notice of injury was given to the insurer OR the insurer already paid a PIP benefit; and a 2019-amendment (PA 21) tolling provision pauses the one-year-back period from the date a specific claim is submitted until the insurer formally denies it.

Bottom line for billers: get every auto/PIP bill to the no-fault carrier within 1 year of each date of service. Confirm coordination order (MI allows coordinated/excess medical and tiered/capped PIP choices since the 2019 no-fault reform).

Not legal advice.