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Horizon NJ Health (Medicaid) to Stop Reimbursing 98943

Horizon NJ Health, Horizon’s Medicaid managed care subsidiary, has announced that it will no longer reimburse CPT code 98943, extra-spinal manipulation, as of April 1, 2018Click here to see the announcement in full.

 Further, the announcement states that the only services rendered by a chiropractor that will be reimbursed are “manual manipulation of subluxation of the spine billed under CPT codes 98940, 98941 and 98942.” 

 Despite this assertion, the Horizon NJ Health Provider Manual does declare that an initial evaluation billed under codes 99201-99205 is eligible for payment when billed on the initial visit with appropriate PCP referral. 

 You can find the Provider Manual here (chiropractic coverage on page 3-13).