CommercialCoverageHigh impact
Chiropractic Care 10.01.02
Excellus BlueCross BlueShield·Chiropractic·Chiropractic
Effective date
Jul 17, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has updated their chiropractic care policy effective July 17, 2025, establishing strict medical necessity criteria and explicitly stating that maintenance care, routine X-rays without red flags, and treatment for non-neuromusculoskeletal conditions are not covered. All chiropractic services will be subject to retrospective utilization review.
Action Required
By July 17, 2025: Billing team must ensure all chiropractic claims include comprehensive documentation of neuromusculoskeletal diagnosis, treatment plan with objective measures, and reasonable expectation of improvement. Providers must document all five medical necessity criteria (history/exam/diagnosis, expectation of recovery, standard practice compliance, symptom relation, individualized treatment plans). Stop submitting claims for maintenance care, routine X-rays without red flags, or treatment of non-neuromusculoskeletal conditions as these will be denied. Prepare for retrospective utilization reviews on all chiropractic services.