Louisiana Medicaid covers chiropractic care, but how much it covers depends on the patient’s age. Children and young adults under 21 are covered under the standard Medicaid State Plan through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program. Adults 21 and older are not covered under the regular state plan, but some Medicaid managed care organizations offer chiropractic visits through a separate optional benefit called “In Lieu of Services.”
Coverage for Children and Young Adults Under 21
For beneficiaries from birth through age 20, Louisiana Medicaid pays for manual manipulation of the spine performed by a licensed chiropractor. Reimbursement covers spinal manipulation of up to four regions per visit.1Louisiana Medicaid. Chiropractic Billing Information
A State Plan Amendment that took effect January 1, 2024 set different authorization rules by age:
- Ages 5 through 20: up to 12 dates of service per fiscal year without prior authorization, as long as the care follows a referral from a licensed EPSDT medical screening provider. Visits beyond 12 need both a referral and prior authorization.
- Birth through age 4: every date of service must be prior authorized by the fiscal intermediary before the first treatment.
These visit limits are not absolute. The state applies the same medical necessity standard to all children, and any limit can be exceeded for a beneficiary under 21 when more care is medically necessary.2Medicaid.gov. Louisiana State Plan Amendment 24-0002
What You’ll Need Before the Visit
A written referral from the child’s EPSDT primary care physician is required before chiropractic services are rendered. The referral has to be signed and dated, and it must accompany the claim.2Medicaid.gov. Louisiana State Plan Amendment 24-0002 The chiropractor is also expected to document the diagnosis, chief complaint, history, examination findings, any diagnostic test results, a treatment plan with the planned number of sessions, and progress notes.1Louisiana Medicaid. Chiropractic Billing Information
Coverage for Adults 21 and Older
The standard fee-for-service Medicaid program in Louisiana does not cover chiropractic care for adults. A 2018 Kaiser Family Foundation survey confirmed that the state reported no chiropractic coverage for categorically needy adults under fee-for-service Medicaid.3KFF. Chiropractor Services – Medicaid Benefits
Starting in mid-2022, the Louisiana Department of Health authorized managed care organizations to offer chiropractic care to adult Medicaid members through an “In Lieu of Services” (ILOS) benefit.4Louisiana Healthcare Connections. Seeking Providers for New Medicaid Chiropractic In Lieu of Service Under federal rules at 42 CFR § 438.3(e)(2), an ILOS lets a managed care plan cover a medically appropriate, cost-effective substitute for a service already in the state plan. The chiropractic version is aimed at giving adults with neuromusculoskeletal conditions a non-opioid option for pain and reducing emergency room visits for pain.5Louisiana Department of Health. In Lieu of Services – Chiropractic Services Policy
What the Adult Benefit Covers
Participating plans cover up to 18 chiropractic treatment sessions per year without prior authorization. Additional sessions may be covered but require the plan’s approval. No primary care referral is needed.6Louisiana Department of Health. MCO Manual – In Lieu of Services A session counts as everything done on a single date of service.
Each visit can include spinal manipulation of up to five regions plus a maximum of two additional treatments, such as mechanical traction, therapeutic exercises, massage therapy, electrical stimulation, ultrasound, or dry needling. X-rays are covered when they’re needed to establish a diagnosis, limited to the minimum views needed; repeat imaging isn’t covered unless symptoms worsen or the clinical picture changes.7Humana. Chiropractic Services ILOS Policy The first visit must include a documented treatment plan with duration, frequency, goals, and how progress will be measured; follow-ups record progress against those goals.6Louisiana Department of Health. MCO Manual – In Lieu of Services
Which Managed Care Plans Offer It
The ILOS is voluntary for each MCO, so not every Louisiana Medicaid managed care plan carries the chiropractic benefit. Adult members should call their plan to confirm. These plans have adopted it:
- Humana Healthy Horizons, originally effective January 1, 2023, with a current version effective July 20, 2026. Up to 18 sessions annually without prior authorization for members 21 and older with full benefits.7Humana. Chiropractic Services ILOS Policy
- Healthy Blue, effective August 1, 2022, same 18-session structure.8Healthy Blue. Chiropractic In-Lieu of Services
- AmeriHealth Caritas Louisiana, effective February 2023, with the benefit capped at 300 total enrollees per year.9AmeriHealth Caritas Louisiana. Chiropractic Services for Adults – In Lieu Of
UnitedHealthcare Community Plan also has an approved chiropractic services policy on the Louisiana Department of Health’s managed care policy archive, with a comment period that closed in June 2025 and a status of “Approved.”10Louisiana Department of Health. Medicaid Managed Care Policies and Procedures Archive – 2025
What Isn’t Covered
Louisiana Medicaid’s coverage is limited to spinal manipulation. The State Plan Amendment defines chiropractic services as manual manipulation of the spine. Extraspinal manipulation, billed as CPT 98943, isn’t on the Louisiana Medicaid fee schedule and isn’t covered.11UnitedHealthcare. Manipulative Therapy – Louisiana Ancillary treatments such as massage therapy, therapeutic exercises, and dry needling are only paid for as part of the adult ILOS through managed care, not under the state plan for children.
If You Have Both Medicare and Medicaid
For dual-eligible beneficiaries, Medicare is the primary payer for chiropractic manipulation. Under Louisiana administrative code, Medicaid coverage for Medicare Part B crossover claims is limited to services also covered under Title XIX, and payment for coinsurance and deductibles is capped at the total Medicaid allowable cost for each covered service.12Cornell Law Institute. La. Admin. Code Tit. 50, § I-8303 Several of the MCOs that offer the chiropractic ILOS also run dual Medicare/Medicaid plans, which can leave eligible patients with little or no out-of-pocket cost.