Chiropractic Handbook
 
 

 

General Information

Recipient Information

Transportation to Medical Appointments

Medicaid-eligible recipients may use specialized medical vehicle (SMV) transportation to receive chiropractic services. If a recipient has a disability or a condition that contraindicates common carrier transportation, a physician, physician assistant, nurse midwife, or nurse practitioner is required to complete a Certification of Need for Specialized Medical Vehicle Transportation form (PDF), HCF 1197, to certify the recipient’s coverage for SMV transportation.

The medical provider gives the completed form to the recipient who then gives the form to the SMV provider.

Specialized Medical Vehicle Trips Exceeding One-Way Upper Mileage Limits

Wisconsin Medicaid requires a prescription for SMV trips that exceed Wisconsin Medicaid’s one-way mileage limits.

This prescription is required in addition to the Certification of Need for Specialized Medical Vehicle Transportation form. The prescription must be renewed upon expiration and must include the following:

A provider, such as a chiropractor, referring an SMV-eligible recipient to a Medicaid-covered health service that is farther than the upper mileage limit is required to write a prescription for the recipient to give to the SMV provider. The SMV provider uses the prescription to obtain PA for SMV trips exceeding one-way upper mileage limits.

Wisconsin Medicaid one-way upper mileage limits are:

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Chiropractic Services Handbook
PHC 1306, October 2004