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Explanation of Chiropractic Benefits for FEP Members

Chiropractic benefits available under FEP Basic and Standard Options are limited to covered chiropractic services and specific physical therapy services.

Effective for services provided on and after January 1, 2002 under Basic Option and on and after January 1, 2006 under Standard Option, FEP considers chiropractors to be covered professional providers when performing services within the scope of their licensure or certification.

Benefits are provided for only medically necessary chiropractic services that are considered “covered” under FEP and performed by providers within the scope of their licensure. The FEP brochure defines these services as the initial office visit, the initial set of x-rays, and spinal manipulations (CPT Codes 98940, 98941 and 98942). “Initial” means the very first office visit and set of x-rays provided and billed by each chiropractor for each condition/diagnosis in a calendar year. Twelve is the maximum number of manipulations per calendar year for Standard Option; 20 is the maximum number for Basic Option.

FEP also provides limited benefits for covered physical therapy services provided by licensed chiropractors who perform within the scope of their licensure or certification (i.e. appropriately licensed or certified to perform physical therapy services).

The following CPT procedure codes represent the physical therapy procedures and the combined physical and occupational therapy procedures that are covered:

For additional information or questions, call Federal Provider Services, 202-488-4900.