On July 21, 2026, the New Jersey Board of Chiropractic Examiners made a precedential decision, concurring with the Association of New Jersey Chiropractors' (ANJC) position paper on chiropractic X-ray guidelines. In plain terms, the board ruled, consistent with the ANJC position, that insurance companies cannot use medical X-ray rules or recommendations, like those written by the American College of Radiology (ACR), to decide whether a chiropractor's X-ray was necessary. From now on in New Jersey, only guidelines authored by chiropractors can be used to judge chiropractic imaging decisions.
This might sound like a small technical rule. But it could have a big effect on chiropractors, patients and insurance companies, not just in New Jersey, but possibly across the whole country. Anthem Blue Cross Blue Sheild has adopted these guidelines in multiple states already, including Colorado, Connecticut, Indiana, Georgia, Kentucky Maine, Missouri, Nevada, New Hampshire, Ohio Virginia, and Wisconsin.
What Was the Problem?
For the past few years, some insurance companies have used medical guidelines built for doctors and hospitals to review chiropractic X-ray claims. These guidelines often say X-rays are only "medically necessary" in narrow situations, like when a patient has been in pain for many weeks, or shows specific "red flag" symptoms such as suspected fractures or infections.
This allopathic approach is not consistent with how the chiropractic profession actually works. Most chiropractic techniques require hands-on treatment with observation of the underlying tissue, whereas most initial allopathic intervention is pharmaceutical. Chiropractic care often relies on X-rays early on to check the position and movement of the spine, congenital anomalies, degenerative changes, among many other things before deciding on a treatment plan. The ANJC's position paper, issued in December 2025, presented the argument in detail. It postulated that medical guidelines were never designed for chiropractic biomechanics, and that using them to deny X-ray claims could even create legal risk for chiropractors if a patient is later harmed because an X-ray was skipped.
Why New Jersey Law Matters
New Jersey has a specific law, N.J.S.A. 45:9-14.5(d), that says no one who is not a licensed chiropractor may make a "utilization management decision" that limits or restricts chiropractic care. In simple terms, only a chiropractor can decide what chiropractic treatment a patient needs.
The New Jersey Board of Chiropractic Examiners also has a history of pushing back on outside standards. As far back as 1997, the Board rejected the Mercy Guidelines as a way to judge chiropractic treatment, determining that decisions about care must be based on the details of each patient's case, not on a one-size-fits-all rulebook. The July 2026 decision follows that same reasoning, but this time applied to X-ray and imaging guidelines written by medical organizations rather than chiropractic ones.
What This Means for Chiropractors and Patients
For DCs in New Jersey, this decision offers meaningful protection. Insurance companies can no longer rely upon ACR guidelines or similar medical rules to determine medical necessity, or lack thereof, to deny payment for X-rays that a DC deems are clinically needed. It also may lower the risk that a chiropractor is accused of ordering "unnecessary" imaging, since the state's own licensing board has held that medical guidelines do not apply.
Could This Spread to Other States?
It already has. This is where the decision could matter well beyond the borders of New Jersey. If insurers are pushing this approach nationwide, chiropractic boards and associations in other states may now look at New Jersey as a precedent to follow.
Other states may have scope-of-practice laws similar to New Jersey's, which say only a licensed chiropractor can make treatment decisions for chiropractic patients. Chiropractic groups in those states could use New Jersey's decision, and its legal reasoning, as a model when asking their own boards to take a similar stand. A clear, formal board ruling like this one can carry weight even outside its home state, especially when other states are weighing similar disputes with the same insurers.
For now, New Jersey has drawn a clear line: In the Garden State, chiropractic care must be judged by chiropractic standards – period. Whether this becomes the national approach or triggers pushback from insurers in other ways will depend on how other states respond in the months ahead.
