Chiropractic Care - (CPG278) | CIGNA Coverage Update

TL;DR: Cigna Healthcare modified CPG278, its chiropractic care coverage policy, effective December 16, 2025. Here's what billing teams need to do.

CPG278 covers a wide range of chiropractic services — from spinal manipulation (CPT 98940–98943) to therapeutic modalities (CPT 97010–97150) — and this update clarifies which codes fall into medically necessary, experimental, or non-covered buckets. If your practice bills chiropractic services to Cigna, the code-level distinctions in this update carry real claim denial risk. Review your charge capture now, before the effective date of December 16, 2025.

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Quick-Reference Table

Field	Detail Copy
Payer	Cigna Healthcare
Policy	Chiropractic Care (CPG278)
Policy Code	cpg278_chiropractic_care
Change Type	Modified
Effective Date	December 16, 2025
Impact Level	High
Specialties Affected	Chiropractic, Physical Medicine & Rehabilitation, Occupational Therapy, Athletic Training
Key Action	Audit charge capture for all 42 affected CPT and HCPCS codes before December 16, 2025

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Cigna Chiropractic Care Coverage Criteria and Medical Necessity Requirements 2025

The Cigna chiropractic care coverage policy under CPG278 ties reimbursement directly to measurable functional improvement. Treatment must be restoring function — not maintaining it. That single distinction drives most of the coverage decisions in this policy.

Cigna defines medical necessity for chiropractic services around a patient's ability to reach specific functional goals within a reasonable timeframe. Benefits end when the patient stops progressing toward those goals. This is not a "keep treating as long as the patient wants" standard.

The policy sets a reasonable trial of care at 2–4 weeks for initial chiropractic treatment. That trial period is shaped by six factors: diagnosis, clinical evaluation findings, stage of condition (acute, sub-acute, or chronic), severity, and patient-specific factors including age, gender, medical history, and psychosocial factors. Document all six in your clinical notes before billing.

Spinal manipulation — billed under CPT 98940, 98941, 98942, or 98943 depending on the number of spinal regions treated — is the core covered service. These codes are considered medically necessary when criteria are met. CPT 98943 covers extraspinal manipulation of one or more regions and also qualifies under the same medical necessity standard.

The policy also covers a wide range of therapeutic modalities and procedures — CPT 97010 through 97150 and CPT 97530 — when medical necessity criteria are satisfied. This includes hot/cold packs (97010), mechanical traction (97012), electrical stimulation (97014 unattended, 97032 manual), and manual therapy techniques (97140). Coverage for these codes is conditional, not automatic.

Prior authorization requirements are not explicitly detailed in the CPG278 policy text itself. However, Cigna plan-level prior auth requirements may apply depending on the patient's specific benefit plan. Check eligibility and benefits for each patient before the first visit.

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Cigna Chiropractic Care Exclusions and Non-Covered Indications

This is where CPG278 bites hardest. Cigna draws clear lines across three categories: experimental/investigational, educational/training, and not medically necessary. Billing into any of these categories will generate denials.

Experimental and Investigational Codes

Cigna Healthcare considers the following services experimental or investigational under this coverage policy:

Dry needling (CPT 20560 and 20561) is a particular watch item here. It's increasingly common in chiropractic and physical medicine settings, and chiropractors in states that permit it often bill it alongside manipulation. Cigna will not cover it under this policy. If you're bundling dry needling into chiropractic visits, separate it on the claim and expect a denial. Don't assume a modifier will fix it — Cigna's position is the service itself is unproven.

Vertebral axial decompression (HCPCS S9090) is another common upsell in chiropractic practices. Cigna won't pay for it. Period.

Not Medically Necessary Codes

Two specific modality codes are explicitly designated as not medically necessary under CPG278:

#	Excluded Procedure Copy
1	CPT 97016 — Vasopneumatic devices
2	CPT 97026 — Infrared therapy

Remove these from your chiropractic charge capture templates. They won't clear medical necessity review regardless of documentation.

Educational or Training — Not Medical Benefits

Cigna treats the following as educational or training services, not medical benefits. These fall outside chiropractic billing guidelines entirely:

HCPCS S8990 is the one to watch closely. Maintenance therapy is explicitly excluded. If your documentation shows a patient has plateaued and you're treating to maintain function, Cigna will not pay. This is consistent with the policy's core medical necessity standard — progression required, maintenance not covered.

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Coverage Indications at a Glance

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Cigna Chiropractic Billing Guidelines and Action Items 2025

Copy Action Items

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CPT, HCPCS, and ICD-10 Codes for Chiropractic Care Under CPG278

Covered CPT Codes (When Medical Necessity Criteria Are Met)

Not Covered / Experimental Codes

Note: No ICD-10-CM codes are specified in CPG278. Cigna does not restrict coverage to specific diagnosis codes in this policy — medical necessity is determined by functional criteria and clinical documentation, not diagnosis code alone.

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