Doctors of chiropractic (DC) in Washington State may serve as attending or concurrent care providers for injured workers with musculoskeletal complaints as an accepted condition. Complaints may be for spine and/or extremity occupational conditions.
Chiropractors manage about one-third of the state’s occupational low-back injuries and are experts at conservative musculoskeletal management. Like care rendered by other health-care providers, chiropractic care for injured workers must be curative and rehabilitative.
Typical chiropractic services include evaluation and diagnosis, manipulation of spine and/or extremities, rehabilitative exercises and home exercise programs. If on the approved examiner list, chiropractic attending providers may give impairment ratings. No authorization is needed to refer for concurrent care or transfer care to a chiropractor.
L&I's Chiropractic Consultants may provide a variety of useful services for attending providers who need help or guidance with an injured worker. Claim managers or Occupational Nurse Consultants may sometimes recommend that an attending provider obtain a Chiropractic Consultant evaluation to address questions on the claim.
Attending Providers may refer patients or set up telephone peer-to-peer consultation. Common services outlined:
- Care and treatment planning for extended conservative care
- Work-relatedness or causation of a condition
- Guidance with return to work and/or resolving employer issues
- Guidance with advanced diagnostics, specialist referral or consultation
- Closing examinations (including permanent disability ratings if the Chiropractic Consultant is also on the department’s Approved Examiner List)
- Informal occupational health advice (some consultants in your community may be willing to volunteer to coach providers on best practices to optimize your ability to care for injured workers)
- Learn more about the Chiropractic Consultation Program.
Reimbursement for Chiropractic Services
Chiropractic services in Washington workers’ compensation are covered under L&I payment policy which differs from other payers and workers’ compensation in other states.
Evaluation and Management codes cover initial and established visits as well as various consultation codes used to coordinate with other providers and L&I.
Chiropractic services are unique in WA L&I in that our local chiropractic care visits (Local codes 2050A-2052A) are based on complexity, similar to an evaluation and management code, rather than by number of regions like most chiropractic codes. Be alert to documenting the clinical decision-making complexity, not just the number of spinal regions and/or extremities.
Other covered services include: Physical medicine (Local code 1044M), independent medical exams, impairment ratings, and radiology services.
The Fee schedule look-up tool is useful for a quick check of payment by code and links to the larger payment policy overview.
RCWs, WACs, and Bylaws
- WAC 296-20-0100 for IICAC (app.leg.wa.gov)
- RCW 51.36.015 Chiropractic care and evaluation
- RCW 51.36.060 Duties of attending physician
- RCW 51.36.150 Industrial insurance chiropractic advisory committee
- WAC 296-20 Medical aid rules
- WAC 296-21 Reimbursement policies: Psychiatric services, biofeedback, physical medicine.
- WAC 296-23 Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing -- Drugless therapeutics, etc.
- WAC 296-27 Recordkeeping and reporting