Chiropractic insurance billing in Wyoming.

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 Wyoming are processed by Noridian Healthcare Solutions (JF). Check its applicable Local Coverage Determination and documentation requirements for the date of service.

Carriers listed for Wyoming include Blue Cross Blue Shield of Wyoming; UnitedHealthcare; Cigna; Aetna; Mountain Health Co-Op; Medicare / Wyoming Medicaid (government payers). Check the member’s product, network, claim destination and applicable chiropractic policy.

Wyoming is a comparatively LOW-delegation chiropractic market, and one notable specifics make it different from neighboring states.

• For Cigna, use the current member ID card and provider portal to identify the chiropractic administrator and claims destination. When a benefit is ASH-administered, its Client Summary identifies covered services, review requirements and where claims go; do not infer the route from a historical statewide announcement.
• Blue Cross Blue Shield of Wyoming (BCBSWY) — the dominant commercial carrier — manages chiropractic/physical-medicine prior authorization IN-HOUSE through its own provider tools (Availity Authorization Pre-Check / BCBSWY precertification), not through a third-party chiropractic-network manager.
• UnitedHealthcare members in Wyoming follow UHC’s national pattern: chiropractic/outpatient-therapy authorization and Medicare Advantage prior authorization are managed through Optum / Optum Physical Health (entered via the UnitedHealthcare Provider Portal, adjudicated in Optum systems).
• Other carriers active in Wyoming — Aetna and Mountain Health CO-OP — administer chiropractic under their own plan rules; some national Aetna/Anthem product lines may still route chiropractic to ASH even though local plans do not. BOTTOM LINE: always verify on the member’s ID card/portal whether chiropractic is handled by the health plan directly (for example, BCBSWY or a directly administered Cigna benefit) or carved out to Optum (UHC) or ASH (some national Aetna/Anthem plans), because that determines where credentialing, prior auth/treatment-plan submission, and claims go; misrouting is a leading denial cause. Workers’-comp chiropractic in Wyoming goes through the DWS Workers’ Compensation Division / CorVel under the state WC fee schedule; auto/Med-Pay through the member’s auto carrier.

What actually trips up chiropractic billing in Wyoming:

• MEDICAID covers medically necessary chiropractic for children under 21. Since June 1, 2021, adult chiropractic is covered only on Medicare crossover claims; the program reviews documentation and appropriateness.
• For Cigna, identify the current chiropractic administrator and claims destination from the member ID card and provider portal; for ASH-administered benefits, follow the applicable Client Summary. UnitedHealthcare uses Optum through the UHC portal and BCBSWY uses its own provider tools; sending the auth or claim to the wrong entity gets it bounced; confirm the delegated entity on the member’s card before submitting.
• Visit caps / treatment-plan & medical-necessity rules — expect annual visit limits and treatment-plan/re-evaluation requirements with a clear shift from active/corrective to ‘maintenance’ care (maintenance is typically non-covered); plan caps vary, so check the specific Summary of Benefits, and follow BCBSWY’s current authorization rules; UHC’s MA list removes prior authorization for 98940-98942 from October 1, 2026, subject to plan exceptions, while the separate D-SNP list does not include that removal.
• Modifier/coding quirks — on Medicare/MA spinal manipulation (98940-98942) the AT modifier is required for active/corrective care, with correct GA/GY/GZ usage; for covered chiropractor-billed E/M or therapy services, modifier -25 identifies a significant, separately identifiable E/M billed with a same-day manipulation, and -59/-XU identifies distinct services. Original Medicare covers only spinal manipulation, not the DC’s exams, x-rays, or therapies.
• WYOMING CHIROPRACTIC SCOPE is broad — under Wyo. Stat. Ann. 33-10-101 et seq. (Chiropractic Practice Act), Wyoming chiropractors may use manipulative, manual, mechanical, physiotherapeutic and clinical-nutritional methods and may perform venipuncture, acupuncture, and diagnostic x-rays (with referral rights for advanced imaging) but may NOT perform surgery, prescribe legend drugs, practice obstetrics, or administer x-ray therapy — billable scope is wide, but coverage/benefit limits (not scope) drive most denials.
• WORKERS’ COMP chiropractic is paid by the DWS Workers’ Compensation Division / CorVel under the state WC medical fee schedule with a voluntary preauthorization process — not the commercial rules; bill CMS-1500/UB-04 with notes, and meet the statutory 30-day medical-report deadlines under 27-14-501(a) but payment requires a compensable, accepted claim.
• Insurance-code jurisdiction — any entity providing coverage in Wyoming for medical, surgical, CHIROPRACTIC, physical-therapy and related expenses is subject to the Wyoming Insurance Department (Title 26), and the 45-day prompt-pay rule (Wyo. Stat. Ann. 26-15-124) with attorney-fee/10%-interest exposure is a useful lever on unreasonably delayed clean-claim payment. Not legal advice — verify benefits and current rules per payer.

Largely CONTRACT/PAYER-SET, not fixed by a single Wyoming statute — the initial-claim filing window is whatever the participating-provider agreement or the payer’s provider manual specifies. In practice Wyoming commercial/private payers commonly use a 90-180 day window from the date of service (some plans allow up to 12 months); always confirm the exact number in your contract or the payer’s provider manual, since the dominant Wyoming carriers each set their own deadline — Blue Cross Blue Shield of Wyoming (BCBSWY, the largest commercial carrier), UnitedHealthcare, Cigna, Aetna, and Mountain Health CO-OP.

Wyoming does NOT set a minimum provider-submission floor, but its insurance code regulates how fast the PLAN must act: under Wyoming’s prompt-pay statute, Wyo. Stat. Ann. 26-15-124(a), a claim under a life, accident or health insurance policy must be rejected or accepted and PAID within FORTY-FIVE (45) DAYS after the insurer receives the proofs of loss and supporting evidence (property/casualty claims likewise within 45 days of the claim and supporting bills); if the company’s refusal to pay a covered loss is found unreasonable or without cause, the court may award the claimant a reasonable attorney’s fee plus interest at 10% per year, and an accident/health claim’s 45-day clock is tolled if a genuine question on validity/amount is referred to the Wyoming state medical peer review committee.

That 45-day rule is the insurer’s PAYMENT clock, not the provider’s SUBMISSION deadline, which remains contractual. As of 2025-2026; verify the exact window per payer and contract before relying on any single number.

Federal limit: generally 12 months (one calendar year) from the date of service to submit an initial Medicare fee-for-service claim. Set by the Social Security Act (Section 1842(b)(3)(B)) and CMS (Medicare Claims Processing Manual, Ch. 1), not by Wyoming.

Medicare Advantage plans set their own deadlines (often similar, up to ~12 months) — confirm per plan. Note for chiropractic: Original Medicare covers ONLY manual spinal manipulation to correct a documented subluxation (CPT 98940-98942) with the AT modifier on active/corrective-care claims; the chiropractor’s exams, x-rays, extraspinal manipulation (98943), and therapy modalities are NOT covered..

UHC’s Medicare Advantage code list removes prior authorization for spinal CMT 98940-98942 effective October 1, 2026, subject to plan-specific exceptions. The separate D-SNP list does not include these CMT removals; other product and therapy-code requirements remain separate.

Supplemental routine-chiropractic benefits on Medicare Advantage plans are separate from Original Medicare’s benefit.

Wyoming Medicaid: the timely-filing limit is 365 DAYS (1 year) from the date of service to submit a claim, per the Wyoming Medicaid Provider FAQs / provider manual (claims-processing administered by the state’s fiscal agent). Related rules: if a claim ADJUSTMENT is needed it must be made within 6 MONTHS (180 days) of the date of payment, with overpayment adjustments accepted without that time limit; a VOID is accepted at any time without a timely-filing limit. For MEDICARE CROSSOVER claims, the limit is 12 months (365 days) from the date of service OR six

• months (180 days) from the date of the Medicare payment, whichever is LATER. The submission date is the date the claim is received by Wyoming Medicaid (its fiscal-agent claims processor). CHIROPRACTIC COVERAGE: effective June 1, 2021, adult chiropractic is covered only for Medicare crossovers. Medically necessary chiropractic remains covered for children under 21. Confirm the current manual before relying on these numbers.

Wyoming Workers’ Compensation requires medical providers to file a written medical report within 30 days of accepting a case and within 30 days of each examination or treatment (Wyo. Stat. Ann. 27-14-501(a)); failure can forfeit payment, so a statement about the absence of a separate bill deadline does not remove this reporting duty, and — because Wyoming runs an EXCLUSIVE state-fund (monopolistic) system administered by the Department of Workforce Services (DWS), Workers’ Compensation Division (medical bills processed by the Division’s third-party bill-review contractor, CorVel) — there is no statutory late-payment penalty regime of the kind found in private-carrier states. Practitioner guidance summarizing the statute and the DWS Rules notes there are no time-limit provisions in the statute or rules of procedure for the PAYMENT of medical bills, and no late-payment penalties, because Wyoming uses a state fund. Reimbursement is governed by the DWS-adopted Wyoming Workers’ Compensation Medical Fee Schedule (Wyo. Admin. Code / DWS WC Rules, ch. 9 et seq.); bills must be reasonable, necessary, and directly related to the work injury, submitted on a CMS-1500 (HCFA) or UB-04 with the supporting medical notes, to CorVel (mail: State of Wyoming, PO Box 2087, Portland, OR 97208-2087; or EDI). Treatment may require PREAUTHORIZATION under the DWS preauthorization process. Separately, the injured WORKER’S own claim is time-barred: a claim for benefits must generally be filed within ONE

• YEAR after a non-fatal injury is diagnosed/discovered (and within 3 years from the date of last injurious exposure for occupational disease), per Wyo. Stat. Ann. 27-14-601 et seq.; the Division performs an initial benefit review within 15 days and issues a final determination (or a request for more information, then a final determination within 45 days of that request). PRACTICAL NORM: meet the 30-day medical-report requirements and submit complete CMS-1500/UB-04 bills with records PROMPTLY — payment requires an accepted/compensable claim, current fee-schedule pricing, and (where applicable) preauthorization. Confirm the current DWS Rules and fee schedule before relying on these.

Wyoming is an AT-FAULT (tort) state — it is NOT a no-fault state and has NO mandatory PIP. There is NO fixed statutory number-of-days deadline requiring a provider to SUBMIT medical bills to an auto carrier. First-party medical coverage is OPTIONAL Medical Payments (Med-Pay) a driver may buy; any bill-submission timeframe is set by the individual auto policy (commonly a 1-, 2-, or 3-year window), not by statute — submit promptly per the policy’s notice/proof-of-loss terms.

Once a clean first-party claim is received, the insurer’s PAYMENT clock is governed by Wyoming’s prompt-pay statute, Wyo. Stat. Ann. 26-15-124 (accept/reject and pay within 45 days of proofs of loss and supporting evidence; property/casualty within 45 days of the claim and supporting bills; potential attorney’s fee plus 10%/year interest where the refusal to pay a covered loss is unreasonable or without cause).

The underlying third-party liability (bodily-injury) claim is governed by Wyoming’s FOUR-YEAR personal-injury statute of limitations (Wyo. Stat. Ann. 1-3-105(a)(iv)); on a liability/lien basis, bills are typically presented at settlement.

Wyoming’s minimum auto liability is 25/50/20. Confirm each Med-Pay policy’s notice and submission terms.