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VERMONT MEDICAID CHIROPRACTIC SERVICES REQUEST FORM Please see instructions on page 2Patient Name: Medicaid ID Number: Date of birth: Chiropractor Name: Medicaid Provider #: NPI #: Office Contact
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Vermont Medicaid chiropractic services include coverage for spinal adjustments, manipulations, and other related treatments provided by licensed chiropractors.
Licensed chiropractors who provide services covered by Vermont Medicaid are required to file for reimbursement of chiropractic services.
To fill out Vermont Medicaid chiropractic services, providers must submit claims with the necessary documentation and coding for the services provided.
The purpose of Vermont Medicaid chiropractic services is to provide access to alternative and holistic treatments for musculoskeletal conditions.
The information that must be reported on Vermont Medicaid chiropractic services includes the date of service, type of treatment provided, diagnosis code, and provider information.
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