Chiropractic Care—80%

Benefits are provided for services and supplies provided by a chiropractor with an annual maximum of 24 spinal manipulations. If charges for more than 24 spinal manipulations are submitted, those charges will be denied. These services always require 20 percent coinsurance and these coinsurance expenses do not apply toward the $2,300 annual coinsurance maximum. Services and supplies include:

• Initial office call and evaluation per medical episode.
• Initial plane film diagnostic x-rays of the spine per condition performed or ordered by a chiropractor.
• Spinal manipulations.
• Medical supplies prescribed or dispensed by the chiropractor but limited to a lumbar brace and cervical collar only.

Benefits are not provided for:

1. Manipulations of any parts of the body which are not articulations of the spine.
2. Treatment which is not within the scope of the chiropractor's license.
3. Office calls in addition to spinal manipulations on the same day, except as provided above.
4. Physical therapy performed or prescribed by a chiropractor.
5. Massage therapy.
6. Laboratory or pathology services performed or ordered by a chiropractor.
7. Prescription drugs, medical supplies (except as described above), or durable medical equipment prescribed or dispensed by a chiropractor.
8. Treatment by machine including, but not limited to, vibrasonic therapy, ultrasound therapy, and hydrotherapy.
9. Acupuncture.
10. Any imaging technique not specified as covered including, but not limited to, videofluroscopy and magnetic resonance imaging (MRI).