Understanding the Ohio Medicaid fee schedule for chiropractic claims

Anthem follows all billing guidelines, manuals, and guidance from the Ohio Department of Medicaid, including the modifiers accepted by ODM. The list can be found here.

For participating providers, chiropractic care requires a prior authorization (PA) after:

• The thirtieth visit for members under 21 years of age.
• 15 visits for members 21 years and older.

Acupuncture requires a PA after the thirtieth visit. Providers can refer to our services requiring prior authorization list here. Note that all non-participating providers require a PA for services.

Care providers who render acupuncture must have the acupuncture specialty in the provider network management module (PNM).

If you have questions regarding chiropractic claims billing, please reach out to your provider relationship account management consultant at Ohiomedicaidprovider@anthem.com or refer to our provider website for additional information.

Through our efforts, we are committed to reducing administrative burden and ensuring timely payments because we value you, our care provider partners.