Chiropractic billing services
Billing for chiropractors that handles Medicare's narrow coverage, active treatment rules and therapy bundling, so adjustments are billed correctly and patients know what they owe.
Why chiropractic billing takes specialty knowledge
Chiropractic billing looks simple on paper: a manipulation code chosen by the number of spinal regions treated. In practice, Medicare covers only manual manipulation of the spine to correct a subluxation, and only during active treatment. Exams, X-rays, therapy and maintenance care are not paid by Medicare, and each one needs the right modifier and patient notice. Commercial plans add visit limits, authorization and their own rules for billing therapy on the same day as an adjustment.
SFA Solutions bills chiropractic claims with those rules built in. We match 98940, 98941 or 98942 to the regions documented, apply AT only to active treatment, use GA, GY and GZ correctly for services Medicare will not pay, and add modifier 59 or XS when therapy is performed on a separate region. We also track visit limits so patients are not surprised by a denied claim.
Common codes we work with in chiropractic
| Code | Description |
|---|---|
| 98940 | Chiropractic manipulative treatment, spinal, 1 to 2 regions |
| 98941 | Chiropractic manipulative treatment, spinal, 3 to 4 regions |
| 98942 | Chiropractic manipulative treatment, spinal, 5 regions |
| 98943 | Chiropractic manipulative treatment, extraspinal, 1 or more regions |
| 97140 | Manual therapy techniques, 1 or more regions, each 15 minutes |
| 97110 | Therapeutic exercises, each 15 minutes |
| 97012 | Mechanical traction, 1 or more areas |
| 99203 | New patient office visit, low medical decision making or 30+ minutes |
CPT is a registered trademark of the American Medical Association. Payer rules vary; we check each payer's current policy.
Where chiropractic practices lose revenue
Medicare's AT modifier and active treatment
Medicare pays 98940, 98941 and 98942 only when the treatment is expected to improve the patient's condition, which is shown by the AT modifier. Once care becomes maintenance, the manipulation is no longer medically necessary and should be billed without AT. If you expect Medicare to deny a maintenance visit, an ABN signed in advance with modifier GA lets you bill the patient.
Documenting subluxation
Medicare requires documentation of a subluxation, either by X-ray or by physical exam showing at least two of the four PART elements (pain, asymmetry, range of motion change, tissue or tone change), one of which must be asymmetry or range of motion. The record also needs a treatment plan with goals and frequency. Missing elements are a leading reason for chiropractic audit findings.
Non-covered services for Medicare patients
Exams, X-rays, therapy and extraspinal manipulation (98943) are not covered when furnished by a chiropractor to a Medicare patient. These are statutorily excluded, so they are billed with modifier GY if the patient needs a Medicare denial for secondary insurance. An ABN is not required for excluded services but can still be used as a courtesy notice.
Therapy on the same day as manipulation
NCCI edits bundle manual therapy (97140) into chiropractic manipulation when performed on the same region. When 97140 is done on a separate region, append modifier 59 or XS and document the region. Commercial payers may also require the GP modifier on therapy codes and limit therapy units per visit.
What else affects chiropractic revenue
A/R challenges in chiropractic
Chiropractic A/R is mostly small balances in large numbers. Copays, deductibles and visits beyond the plan's annual limit shift a lot of the revenue to patients, and those balances get old if they are not collected at the front desk. Personal injury and auto cases are the other big source of aging, since payment may wait on a no-fault carrier's review or on a settlement. We separate those accounts so they are followed on their own timeline and do not hide routine insurance problems.
Credentialing considerations
Chiropractors enroll under taxonomy 111N00000X, and Medicare enrollment covers only manual manipulation of the spine. Chiropractors cannot opt out of Medicare, so a DC who treats Medicare patients for covered manipulation needs to submit claims as a participating or non-participating provider. Many commercial plans send chiropractic care through networks such as American Specialty Health or Optum Physical Health, which means a separate credentialing application and network agreement on top of the health plan itself.
Payer considerations
Plans that use a chiropractic network often require a treatment plan submission and approval after a set number of visits, and claims outside the approved visits are denied. Auto claims in no-fault states run through personal injury protection rules, and workers' compensation follows the state fee schedule and its own authorization process. Medicaid coverage for chiropractic is limited or absent in many states, so eligibility and coverage should be checked before the first visit.
Chiropractic coding details that affect payment
ICD-10 considerations
Medicare chiropractic claims generally list the subluxation first, using codes from M99.0 (segmental and somatic dysfunction) or M99.1 (subluxation complex) by spinal region, with the related neuromusculoskeletal condition as a secondary diagnosis. The number of regions supported by the diagnoses should match the CMT code billed, so a 98941 claim needs diagnoses for at least three regions. Low back pain was expanded in 2021 into M54.50, M54.51 and M54.59, so the retired M54.5 code will reject. Radiculopathy codes in M54.1 are region specific, and auto and personal injury claims usually need external cause codes and a 7th character such as A or D on injury codes like S13.4 (sprain of cervical spine ligaments).
Modifiers to watch
| AT | Placed on 98940 through 98942 for Medicare patients only while the treatment plan shows expected improvement. |
|---|---|
| GA | Used when a signed ABN is on file for a manipulation Medicare is expected to deny as maintenance care. |
| GZ | Used when the practice expects a Medicare denial for medical necessity but no ABN was obtained, which means the patient cannot be billed. |
| GP | Required by Medicare and many other payers on therapy codes such as 97110 to show they were delivered under a physical therapy plan of care. |
| 25 | Added to an E/M on the same day as manipulation only when a new problem or significant change justifies work beyond the usual pre-manipulation assessment. |
Global periods
Chiropractic manipulation codes carry a 0-day global, and the pre-manipulation assessment is included in the CMT code. An E/M is separately payable only for a new condition, a new injury or a formal re-evaluation, with modifier 25.
Medicare considerations
Medicare chiropractic coverage is described in the Medicare Benefit Policy Manual, Chapter 15, Section 240, and each MAC adds a local coverage policy with documentation requirements. When an X-ray is used to show the subluxation, it generally must be taken within 12 months before or 3 months after the start of the course of treatment. Chiropractic claims have historically had high improper payment rates in CMS reviews, so records requests are common.
Chiropractic billing KPIs to track
- AT modifier rate by patient episode. A patient who keeps the AT modifier for many months without updated goals is a common audit target.
- Visits denied over plan limits. This shows whether visit counts and network approvals are being checked before each appointment.
- Time-of-service collection rate. Most chiropractic revenue is small patient balances, so collecting at the visit has more impact than statement follow-up.
- Personal injury A/R over 120 days. Tracking PI and auto balances separately keeps settlement-driven aging from hiding routine insurance problems.
Chiropractic billing audit checklist
- Confirm each Medicare manipulation claim lists a subluxation diagnosis for every region billed.
- Check that the CMT level matches the number of regions documented in the visit note.
- Review the treatment plan for goals, frequency and duration before AT is applied.
- Verify that excluded services for Medicare patients carry GY and are not billed with AT.
- Confirm 97140 billed with manipulation documents a separate body region.
- Match network visit approvals to billed dates so visits outside the approved range are caught before submission.
How SFA runs chiropractic billing
We review your documentation templates for subluxation, PART elements and treatment plans.
Eligibility, visit limits and authorizations are checked before each patient's plan of care starts.
Claims are coded by region with AT, GA, GY, 59 or XS as the visit requires, and most clean claims are submitted within 24 hours.
Denials are corrected or appealed, and patient balances for non-covered services are billed correctly.
The services that matter most for chiropractic
Billing Compliance
Chiropractic is a frequent Medicare audit target, so subluxation and treatment plan documentation must hold up.
Learn moreEligibility Verification & Prior Authorization
Visit limits and authorization rules vary by plan, and checking them first helps prevent denied adjustments.
Learn moreDenial Management
Denials for missing AT, bundled therapy or exceeded visit limits can often be corrected and resubmitted.
Learn moreWhat practices typically see with SFA
Averages and selected client results. Your free audit shows where your own numbers stand today.
Target for the claims we manage, not a measured average.
Highest improvement seen in selected client results.
Largest drop in A/R days seen in selected client results.
Targeted for submission within 24 hours after final review.
From primary care and nurse practitioners to surgery and imaging.
We work inside the system your practice already uses.
Results vary by practice, specialty, payer mix, claim volume, billing history, documentation and other factors. Performance figures represent average or selected client results and are not guarantees of future performance. The 95% figure is a clean-claim target, not a measured cohort. The client-results page does not include a measurement period, starting collections, or practice size.
Chiropractic billing questions
What does the AT modifier mean?
AT means active or corrective treatment. Medicare requires it on 98940-98942 when care is expected to improve the patient's condition. Maintenance care is billed without AT and is not paid by Medicare.
Does Medicare pay chiropractors for exams or X-rays?
No. Medicare pays chiropractors only for manual manipulation of the spine to correct a subluxation. Exams, X-rays and therapy performed by a chiropractor are excluded and become the patient's responsibility.
Can I bill 97140 with an adjustment?
Yes, when it is performed on a different body region than the manipulation. Append modifier 59 or XS and document the separate region and the time spent.
When do I need an ABN for a Medicare patient?
Use an ABN when you believe Medicare will deny a normally covered service as not medically necessary, such as a manipulation during maintenance care. It must be signed before the service and the claim carries modifier GA.
Do you handle personal injury and auto claims?
We can bill auto and personal injury claims where your practice accepts them. Rules differ by state and insurer, so we confirm each carrier's requirements before submitting.
See what your chiropractic billing is missing
Send us a few details and an RCM specialist who knows chiropractic will review where claims are denied, underpaid or left unbilled.
- A clear walkthrough of what we find
- Reply typically within one business day
- No commitment
Request your free practice audit
An RCM specialist typically replies within one business day.