MedicaidCoverageHigh impact
Chiropractic - In Lieu of Services (ILOS) - MEDICAID - LOUISIANA (Revised)
Humana·LA · Chiropractic·Medicaid
Effective date
Jul 20, 2026
We identified it
Jul 16, 2026
Summary
Humana Healthy Horizons Louisiana Medicaid now covers chiropractic services as an In Lieu of Services (ILOS) alternative for members 21+ with neuromusculoskeletal spine conditions. Up to 18 treatment sessions are covered annually without prior authorization; additional sessions require plan approval. Initial visits must include a documented treatment plan with care level, goals, and effectiveness measures. Spinal manipulation is limited to 5 regions per visit, with maximum 2 additional treatments (dry needling, electrical stimulation, manual therapy, etc.) allowed per date of service.
Action Required
Before July 20, 2026: Billing team must implement the following in the billing system and provider education: (1) Update claim processing to allow up to 18 chiropractic sessions per calendar year for Louisiana Medicaid members age 21+ without prior authorization; (2) Configure system to require prior authorization for chiropractic sessions beyond 18 per year; (3) Add validation rules to reject claims with spinal manipulation exceeding 5 regions on a single date of service; (4) Add validation rules to reject claims with more than 2 'other treatments' (CPT 97012, 97014, 97022, 97032, 97035, 97110, 97112, 97116, 97124, 97140, 20560, 20561) on a single date of service; (5) Create claim rejection logic to deny repeat X-rays (CPT 72020-72220) without documented worsening symptoms, symptom pattern changes, or new symptoms; (6) Require documentation of treatment plan on initial visits including care level, treatment goals, and effectiveness measures; (7) Ensure member eligibility verification confirms 'P' linkage (full benefits including physical and behavioral health) at time of service; (8) Do NOT require referral from PCP for chiropractic access. Update provider portal and encounter forms to reflect these requirements. Claims submitted without compliance will be denied.