Chiropractic billing
Chiropractic billing services
We handle billing for chiropractors: manipulation, exams, therapies, Medicare rules and personal injury cases. Claims go out within 24 hours of receiving charges, every denial is worked within 5 business days, and billing starts at 2.5% of collections.
- CMT coded by number of spinal regions treated
- Medicare AT, GA and GY modifiers applied correctly
- Visit limits and personal injury claims tracked
Why chiropractic billing is different
Chiropractic claims follow their own coverage rules
Chiropractic billing is different because payers cover a narrow set of services, and Medicare covers only one: manual manipulation of the spine to correct a subluxation. Everything else depends on the payer and the plan.
Spinal regions drive the code
Chiropractic manipulative treatment is coded by how many spinal regions are treated: 98940 for 1 to 2, 98941 for 3 to 4, 98942 for 5. The note must name each region and the findings that support treating it.
Medicare active vs. maintenance care
Medicare pays for active corrective treatment, billed with the AT modifier. Maintenance care is not covered, so an ABN and the GA modifier are needed if you plan to bill the patient.
Services Medicare excludes
For chiropractors, Medicare does not pay for exams, X-rays, therapies or extraspinal manipulation. These are billed with the GY modifier when a denial is needed for secondary insurance or patient billing.
Subluxation documentation
Medicare expects the subluxation to be the primary diagnosis and documented with findings such as pain, asymmetry, range-of-motion changes and tissue changes, plus a treatment plan with goals.
Same-day E/M and therapies
An exam on a manipulation day needs modifier 25 and a separate problem or new episode. Therapies like 97140 on a region that was manipulated are bundled unless a modifier is supported by a different region.
Visit caps and personal injury
Commercial plans often cap chiropractic visits per year or require authorization after a set number. Auto accident and personal injury cases may bill an auto carrier or an attorney lien instead of health insurance.
Common codes
Chiropractic codes we bill often
| Code(s) | What it is | What we watch for |
|---|---|---|
| 98940 / 98941 / 98942 | Spinal manipulation: 1–2, 3–4 or 5 regions | Regions in the note match the code; AT modifier for Medicare active care |
| 98943 | Extraspinal manipulation (e.g. shoulder, knee) | Not covered by Medicare; commercial coverage varies |
| 99202–99215 | New and established patient exams | Modifier 25 only for a separately identifiable exam on a CMT day |
| 97140 | Manual therapy (timed) | Separate region from manipulation, with a supported modifier |
| 97110 / 97112 | Therapeutic exercise and neuromuscular re-education (timed) | Units supported by documented minutes; payer visit limits |
| 97012 | Mechanical traction | Plan coverage and bundling rules vary |
| 72040 / 72100 | Cervical and lumbar spine X-rays | Not paid by Medicare when ordered by a chiropractor; commercial rules vary |
Codes and rules change. We check current CPT guidance and each payer’s policy before submission.
Common denials we prevent
Chiropractic denials we stop before they happen
Most chiropractic denials come from modifiers, documentation and coverage limits. We check each one before the claim goes out.
- Medicare CMT claims missing the AT modifier or subluxation diagnosis
- Maintenance care billed without an ABN and GA modifier
- CMT level higher than the number of regions documented
- Manual therapy billed on the same region as manipulation
- Visits beyond the plan’s annual limit or authorization
- Non-covered services sent without GY where secondary billing depends on it
- Accident cases sent to health insurance before the auto or PI carrier
What we handle
Everything between the visit and the payment
Our core focus is behavioral health, and we bill chiropractic with the same team, the same promises and CPB-certified billers on the team.
- Insurance eligibility, benefits and visit-limit checks before care starts
- Charge entry and coding review of CMT levels, therapies and modifiers
- Claim submission within 24 hours of receiving charges
- Payment posting and ERA reconciliation
- Denial correction, resubmission and appeals within 5 business days
- A/R follow-up on unpaid and underpaid claims
- Credentialing and payer enrollment for new chiropractors
- Patient statements and balance tracking
- Monthly reports on collections, denials and A/R
Pricing
Clear pricing for chiropractic practices
Billing starts at 2.5% of collections, or a flat monthly fee. There is no setup fee and no long-term contract. Credentialing starts at $80 per payer, and 5 commercial payers are credentialed free with billing.
Common questions
Do you bill workers’ compensation?
Yes. We bill workers’ compensation carriers directly, separate from health insurance. We set up each injury case with the carrier, claim number, adjuster and employer details, and follow the state’s fee schedule, forms and documentation rules.
What does Medicare cover for chiropractors?
Medicare covers manual manipulation of the spine to correct a subluxation (98940 to 98942) when the care is active and corrective. Exams, X-rays, therapies and extraspinal manipulation ordered or performed by a chiropractor are not covered.
When do we need an ABN?
When you expect Medicare to deny care as not medically necessary, such as maintenance care, and you want to bill the patient. A valid ABN signed before the service lets you bill with the GA modifier.
Can we bill an exam and an adjustment on the same day?
Yes, when the exam is significant and separate from the usual pre-manipulation assessment, such as a new patient, a new injury or a re-exam. It is billed with modifier 25 and the note must support it.
Do you bill personal injury and auto cases?
Yes. We bill the auto or personal injury carrier with the claim details it needs and track the balance. Rules differ by state, so we follow the process that applies to your cases.
Do you call our patients about balances?
No. Our billing team does not talk to patients. We send statements and track balances, and patient calls go to your front desk or to an optional RevenueCTRL virtual assistant.
Guides from our team
Learn more before you decide
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What common denial codes mean (CO-16, CO-18, CO-50, CO-97, CO-197, PR-1 and more) and how to fix each, for mental health and medical practices.
Read the guide →Medical Billing Services for Small Practices: Complete Guide to Maximizing Revenue
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Read the guide →Find out what your claims are leaving on the table
Tell us about your practice. We will review 90 days of claims and show you what is recoverable, at no cost.
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