There is NO where they show how many visits are allowed. Patients have the number 20 in their head or they've been told that. Red flags do come up when there's too much treatment. Chiro is supposed to be ACTIVE TREATMENT that gets the patient over this injury. (I know, most elderly patients have so much arthritis or damage that they'll never be 100%, but they will have flare ups of the same thing).
The LCD I have shows Category 1 is "short term" treatment (this would be headache, lumbago, pain etc).
Category 2 is "moderate term" treatment (this includes sprain/strain, spondylolisthesis, torticollis, disc disorders)
Category 3 is "long term" treatment (herniated discs, DJJ, DJD, sciatica) if you have a report date of an X-ray or MRI that SHOWS the problem it helps support the diagnosis. Particularly if you get a request for additional information, ALWAYS send the reports.
I have patients that come 3-4 times per year, and one guy we see regularly. I haven't had treatment denied, but we're very careful in documentation and making sure the patient understands that Medicare only pays ACTIVE treatment.