Washington
Chiropractic Information
Washington Chiropractic Summary
Washington chiropractors are licensed to diagnose and treat disorders of the musculoskeletal system and nervous system. They may use a variety of techniques, including chiropractic adjustments, soft tissue mobilization, and rehabilitative exercises. Chiropractors in Washington are prohibited from prescribing drugs or performing surgery.
Licensing Requirements
* The word doctor or “Dr.” or physician may be used only in conjunction with the word “chiropractic” or “chiropractor”.
Post-Licensing Education
Continuing Education requirements
25 hours required every year. Max 12 hours may be earned online.
Link: https://app.leg.wa.gov/WAC/default.aspx?cite=246-808-150
requirements for educators
The Chiropractic Quality Assurance Commission (commission) recognizes the Provider Approved Continuing Education (PACE) program in the effort to maintain high standards of continuing education (CE).
Are PACE courses accepted for continuing education requirements?
YES
Washington requires examinations through the National Board of Chiropractic Examiners
Part I, Part II, Part III, Part IV – Required
State Chiropractic Online Resources
Regulatory Authority
Chiropractic Quality Assurance Commission https://doh.wa.gov/licenses-permits-and-certificates/professions-new-renew-or-update/chiropractor-chiropractic-x-ray-technician/commission-information
Washington State Chiropractic Quality Assurance Commission https://doh.wa.gov/licenses-permits-and-certificates/professions-new-renew-or-update/chiropractor-chiropractic-x-ray-technician/commission-information
Chiropractic Statutes and Regulations
Chiropractic defined (scope of practice)
https://app.leg.wa.gov/RCW/default.aspx?cite=18.25.005
Administrative rules
https://app.leg.wa.gov/wac/default.aspx?cite=246-808
WA State Chiropractic Scope of Practice
https://app.leg.wa.gov/RCW/default.aspx?cite=18.25.005
WA State Chiropractic Statutes
https://app.leg.wa.gov/rcw/default.aspx?Cite=18.25
WA State Administrative Code (Rules)
https://app.leg.wa.gov/wac/default.aspx?cite=246-808
Regulation of Health Professions – Uniform Disciplinary Act
https://app.leg.wa.gov/rcw/default.aspx?cite=18.130
Rebating By Practitioners of Healing Professions
https://app.leg.wa.gov/rcw/default.aspx?cite=19.68
Abuse of Children and Adult Dependent Persons
https://app.leg.wa.gov/rcw/default.aspx?cite=26.44.030
Administrative Procedures Act
https://app.leg.wa.gov/rcw/default.aspx?cite=34.05
Public Records Act
https://app.leg.wa.gov/rcw/default.aspx?cite=42.56
Medical Records-Health Care Information Access and Disclosure
https://app.leg.wa.gov/rcw/default.aspx?cite=70.02
Prescription Monitoring Program
https://app.leg.wa.gov/rcw/default.aspx?cite=70.225.020
Abuse of Vulnerable Adults
https://app.leg.wa.gov/rcw/default.aspx?cite=74.34
Mental Illness
https://app.leg.wa.gov/RCW/default.aspx?cite=71.05
Administrative Procedures and Requirements for Credentialed Health Care Providers
https://app.leg.wa.gov/wac/default.aspx?cite=246-12
Whistleblower Complaints in Health Care Settings
https://app.leg.wa.gov/wac/default.aspx?cite=246-15
Standards of professional conduct
https://app.leg.wa.gov/wac/default.aspx?cite=246-16
WA Disciplinary Code for all health professions
https://app.leg.wa.gov/rcw/default.aspx?cite=18.130
Rebating by practitioners of healing professions
https://app.leg.wa.gov/rcw/default.aspx?cite=19.68
Abuse of Children and Adult Dependent Persons
https://app.leg.wa.gov/rcw/default.aspx?cite=26.44.030
State Government Resources
State Legislature Homepage
State Legislature Bill Search Tool
Legislative member roster
State Governor's Office
Secretary of State
Office of the Insurance Commissioner
State Associations
State Chiropractic Coverage
Worker’s Compensation
Labor & Industries Industrial Insurance Chiropractic Advisory Committee
https://www.lni.wa.gov/patient-care/advisory-committees/industrial-insurance-chiropractic-advisory-committee-iicac
Chiropractic care and evaluation for injured workers
https://app.leg.wa.gov/rcw/default.aspx?cite=51.36&full=true#51.36.015
Duties of attending physician for injured workers
https://app.leg.wa.gov/rcw/default.aspx?cite=51.36&full=true#51.36.060
Medical aid rules for providers treating injured workers
https://app.leg.wa.gov/wac/default.aspx?cite=296-21
Reimbursement policies: Psychiatric services, biofeedback, physical medicine providers of injured workers
https://app.leg.wa.gov/wac/default.aspx?cite=296-21
Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing — Drugless therapeutics, etc. for providers of injured workers
https://app.leg.wa.gov/wac/default.aspx?cite=296-23
Become a provider for injured workers
https://lni.wa.gov/patient-care/provider-accounts/become-a-provider/
Medical benefits for injured workers
https://lni.wa.gov/claims/for-workers/claim-benefits/medical-benefits
Independent medical exam rules for injured workers
https://lni.wa.gov/patient-care/treating-patients/independent-medical-exams-ime-and-impairment-rating-information/
WA State Department of Labor & Industries-Chiropractic Services
https://www.lni.wa.gov/patient-care/treating-patients/by-specialty/chiropractic-services
Industrial Insurance Chiropractic Advisory Committee
https://app.leg.wa.gov/wac/default.aspx?cite=296-20-0100
General statute for chiropractic access for injured workers
https://app.leg.wa.gov/RCW/default.aspx?cite=51.36.015
Medical Provider Network Lookup report
https://secure.lni.wa.gov/medical-provider-status/#/selected-npi
Worker Compensation (Labor & Industries) Provider Network Search
https://secure.lni.wa.gov/provdir/
Worker Compensation Chiropractic Consultant Program for Chiropractors
https://lni.wa.gov/patient-care/authorizations-referrals/referrals-to-specialists#consultants
Provider fee schedule details
https://lni.wa.gov/patient-care/billing-payments/fee-schedules-and-payment-policies/policy-2022
Worker Compensation Provider Fee Schedule Lookup Tool
https://lni.wa.gov/patient-care/billing-payments/fee-schedules-and-payment-policies/fee-schedule#/
Worker Compensation Payment Policies
https://lni.wa.gov/patient-care/billing-payments/fee-schedules-and-payment-policies/policy-2022
Medicaid
Washington State Medicaid is called Apple Health
https://www.hca.wa.gov/about-hca/programs-and-initiatives/apple-health-medicaid
Worker Compensation Payment Policies
https://lni.wa.gov/patient-care/billing-payments/fee-schedules-and-payment-policies/policy-2022
Medicaid fee schedule
(Currently benefits are limited to children’s chiropractic services. Adult services will not begin until 1/1/2025)
https://www.hca.wa.gov/billers-providers-partners/prior-authorization-claims-and-billing/provider-billing-guides-and-fee-schedules
Practice Options
| Perform extremity adjustments? | Y |
| Provide nutritional advice? | Y |
| Provide manipulation under anesthesia? | N |
| Provide school enrollment exams? | N |
| Provide sports physical exams? | N |
| Provide return to play exams (including concussion protocol) for sports participation? | N |
| Perform US Department of Transportation exams? | N |
| Treat animals? | N1 |
| Perform acupuncture? | N |
| Perform dry needling? | N |
| Perform intraoral TMJ treatments? | N/A |
| Perform internal coccyx adjustments? | N |
| Are there limits to body areas DCs are allowed to examine and/or treat? | Y2 |
| Are there limits on diagnostic tools DCs are allowed to use? | Y3 |
| Perform venipuncture? | N |
| Perform casting? | N/A |
Qualifications:
1. If the chiropractor doesn’t take a fee, or compensation of any kind, they may provide adjustments to animals.
2. Chiropractic care shall not include the prescription or dispensing of any medicine or drug, the practice of obstetrics or surgery, the use of x-rays or any other form of radiation for therapeutic purposes, colonic irrigation, or any form of venipuncture. https://app.leg.wa.gov/WAC/default.aspx?cite=246-808-570
3. https://app.leg.wa.gov/WAC/default.aspx?cite=246-808-505
WAC 246-808-505
Classification of chiropractic procedures and instrumentation.
(1) Procedures, instruments for treatment and/or diagnostic evaluation used by a doctor of chiropractic shall be classified by the commission as follows:
(a) “Approved”: A procedure or instrument which is taught by a commission approved chiropractic college for patient clinical application and not for research or experimental purposes and is allowable by statute. All factors listed under subsection (4) of this section shall be considered before a procedure or instrument is placed in the approved classification.
(b) “Nonapproved or experimental”: Any procedure or instrument that does not meet with commission approval. A procedure or instrument in this classification shall pass further testing in the laboratory before it can be used on the public. These may be defined by previous declaratory rules or rules and regulations.
(c) “Research or investigational”: A procedure or instrumentation that is not approved, but may have a positive benefit in the diagnosis or care of a patient’s condition. No billing is allowed for procedures or instruments used under this classification.
(2) The commission shall maintain a classified list of chiropractic procedures and instrumentation. The list shall be made available upon request.
(3) A doctor who intends to use a new procedure or instrument in practice shall notify the commission to determine the classification of the procedure or instrument. If the procedure or instrument is not classified or if new information on a previously classified procedure or instrument is available, the doctor shall:
(a) Provide the commission with supporting documentation concerning the use of such a procedure or instrumentation;
(b) Demonstrate sufficient additional training or study for the doctor and utilizing staff to properly use the procedure or instrumentation.
(4) The commission may use the following factors to determine the classification of the procedure or instrumentation, and shall notify the doctor of such classification:
(a) The new procedure or instrument is taught at an approved chiropractic college.
(b) There is a scientific basis for the new procedure or instrument.
(c) The procedure or instrument has a direct and positive relationship to chiropractic care.
(d) Comparison of potential risk to benefit to the patient.
(e) Any other factors the commission may wish to consider.
