Chiropractic Care in Arkansas: What Every Resident Needs to Know

Chiropractic care in Arkansas is regulated under state law, federal Medicare rules, Medicaid benefits, and private insurance contracts. This guide breaks down everything by situation so you can immediately understand what is covered, what is not, and how to access care.

 
1. Understanding Your Coverage Options

A. Medicaid (Arkansas Medicaid Program)

• Adults: Chiropractic services are covered when they are medically necessary and performed by a Medicaid-enrolled chiropractor.
• Children under 21: Covered through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit with no fixed visit limit as long as the care is documented as medically necessary.

Services Medicaid Covers:

• Spinal adjustments (manual manipulation).
• Related examinations and diagnostic assessments.
• Maintenance or wellness-only care is not covered.

Requirements:

• The chiropractor must be enrolled with Arkansas Medicaid.
• Some cases require prior authorization if visits exceed the standard care plan.

B. Medicare (applies nationwide)

• Covers manual spinal manipulation only, when correcting a vertebral subluxation.
• Does not cover X-rays, massage, or wellness adjustments.
• Patients are responsible for 20 percent coinsurance after the Part B deductible.

C. Private Insurance and Marketplace Plans

• Arkansas law requires most state-regulated insurance plans to include musculoskeletal care benefits. Many plans include chiropractic care as part of that benefit.
• Employer-sponsored and Marketplace plans often include between 12 and 20 covered chiropractic visits per year.
• Self-funded employer plans can set their own rules and may not cover chiropractic care unless the employer chooses to include it.
   

2. In-Network vs. Out-of-Network Chiropractors

• HMO plans: You must see an in-network chiropractor. Out-of-network care is not covered unless you have prior approval due to no available provider.
• PPO plans: In-network chiropractors have the lowest cost to you. Out-of-network visits may be covered but at a reduced rate. The chiropractor can bill you for the difference.
• Medicaid: Only Medicaid-enrolled chiropractors are paid.
• Medicare: There is no traditional network, but the chiropractor must accept Medicare assignment to avoid extra costs.

 
3. Common Questions Answered

How many visits per year does insurance cover in Arkansas?

• Medicaid: As many as medically necessary for children; adults usually have a set care plan reviewed by Medicaid.
• Private insurance: Typically 12–20 visits per year.
• Medicare: No fixed limit, but every visit must meet medical necessity criteria.

Do I need a referral?

• Medicaid: Sometimes, especially for children under EPSDT or extended care.
• Private insurance: Many plans require a referral from a primary care physician.
• Medicare: No referral required but strict documentation of subluxation is needed.

Can I go to any chiropractor I choose?

• With Medicaid, only enrolled providers are paid.
• With HMO plans, you must use the network.
• With PPO plans, you can see anyone, but costs are lower in-network.
• With Medicare, any chiropractor who accepts assignment can treat you.
   

4. Steps to Take Depending on Your Coverage

If you are on Medicaid:

Confirm the chiropractor is Medicaid-enrolled.
If the patient is a child, ask your pediatrician for an EPSDT referral.
For adults, ensure the chiropractor submits the required treatment plan.

If you are on Medicare:

Make sure the chiropractor accepts Medicare assignment.
Ask if they will document subluxation for each visit.
Be prepared to pay 20 percent coinsurance.

If you have private insurance:

Check your plan booklet to see if chiropractic care is included.
Ask if you need a referral or prior authorization.
Use an in-network chiropractor to avoid extra costs.
Track the number of visits you have used to avoid unexpected denials.

5. Key for Arkansas Residents

Medicaid covers chiropractic care for both adults and children when medically necessary, but only through enrolled providers.
Medicare covers only spinal manipulation for subluxation with strict documentation rules.
Most private and Marketplace plans include chiropractic benefits, usually with visit limits and referral requirements.
In-network chiropractors are almost always required for full coverage under HMO and Medicaid.
Wellness or maintenance-only adjustments are rarely covered under any plan.