A Big Win For Medicaid Patients and Wisconsin Providers
Starting in May 2026, ForwardHealth / Medicaid, will reimburse Wisconsin doctors that are Medicaid providers for extremity adjustments (98943). Per the handbook:
“CPT code 98943 (manual manipulation of one or more regions outside the spine) is allowed once per DOS and can be billed alongside a spinal manipulation CPT code or on its own.” Here is an article that explains the correct usage of this code. Current reimbursement for 98943 is $28.86.
Keep in mind that Medicaid follows Medicare rules for documentation of medical necessity when billing 98943 with CMT 98940-98942 codes. In other words, billing an extremity code automatically with every adjustment would present a major audit red flag.
They have also updated the prior authorization form and instructions, here. Providers will need to set up a portal account to use the new form. Click the link above or go to the ForwardHealth Provider Portal Account User Guide.
Another Big Win on the Horizon?
“UnitedHealthcare is eliminating authorization requirements for 30% of healthcare services that previously required insurer approval, including some chiropractic services.”
While we are waiting to get specifics, any reduction in cumbersome, time consuming, and treatment-delaying preauthorization process is welcome. UHC has announced that by the end of 2026, preauthorization requirements will be eliminated in 30% of the services that now require it.
We will keep you updated on how this moves forward.
Fulcrum Updates for Wisconsin Providers
As you may have heard, Fulcrum/Chiropractic Care (a Minnesota-based, nonprofit physical medicine benefit management organization) will be ceasing contract operations effective August 31, 2026.
For those of you participating with Fulcrum, please watch your emails from Fulcrum and/or each payer group for further details and timelines. Whole Health Inc. will be taking over most of the below payer groups, and have advised some offices, via email, that they will be in contact.
We strongly recommend you ask Whole Health for a contract to review, along with a Fee Schedule.
Below is a sampling of what we know to date.
Please refer to the FAQ included here: Fulcrum Health Inc. for a full list of the payer groups impacted.
| Aetna/Allina – Termination date with Fulcrum: 07/31/2026 – Contract through MultiPlan to stay in network (non-Minnesota), and SecureCare (Minnesota offices) | Aspirus – Termination date with Fulcrum: 07/31/2026 – Aspirus is working on a transition plan; no further details at this time |
| BPA – Termination date with Fulcrum: 5/31/2026 – Claims for dates of service on or before 5/31/26 must be submitted to Fulcrum no later than end-of-day 7/17/26. – No further details available at this time. | Cigna – Cigna will contract their chiropractic network through First Health. |
| Quartz – Termination date with Fulcrum: 6/30/2026 – Quartz will handle services in-house and will contract with provider groups only. They are focusing their outreach based on member utilization, geographic coverage & network needs. Provider groups that haven’t submitted claims within 12 months may not be contacted. If chosen, Quartz will send a group contract via Docusign and should be received by 6/1/26. | The Alliance -Termination date with Fulcrum: 8/31/2026 – The Alliance is actively finalizing the contract and coordinating transition details with the new provider network partner. Once completed, their new provider network will reach out with next steps. |
| Zelis – Termination date with Fulcrum: 6/30/2026 – No further details available at this time; however, if you are credentialed and contracted directly with Zelis, you should not be impacted by this change. __________________________________________________ Health Partners – The most recent information on Health Partners is that they have contracted with UHC / Optum to manage their chiropractic network. | WPS – Termination date with Fulcrum: 7/31/2026 – Fulcrum is sharing provider credentialing files with WPS. WPS may contact providers or providers may reach out to WPS at Provider Contracting – WPS informed me that the administration of their chiropractic network will transition to Chiropractic Management Services. To remain participating, providers will need to reach out CMS Services LLC. – WPS indicated their termination date with Fulcrum is 7/1/2026 (different than Fulcrum’s termination notice indicating termination on 7/31/26). |