Chiropractic billing
Active care billed with AT, maintenance care handled the right way.
Medicare pays a chiropractor for one thing: manual manipulation of the spine to correct a subluxation. We bill it with the AT modifier when care is active, handle maintenance care with an ABN, and bill commercial plans to their own rules.
- Full-service rate
- 3% to 6% of collections
- Medicare codes
- 98940–98942 with AT
- Maintenance care
- ABN and GA, billed right
- New & smaller practices
- Flexible monthly minimum
What Medicare pays a chiropractor for
Under the Medicare Benefit Policy Manual (chapter 15, section 240), chiropractic coverage is limited to manual manipulation of the spine to correct a subluxation, billed as spinal CMT. No other diagnostic or therapeutic service a chiropractor furnishes or orders is covered, so Medicare does not pay for the exam, x-rays, therapies or extraspinal manipulation.
That makes every Medicare visit a documentation test, and commercial plans pay by different rules again. We bill both inside our full revenue cycle service, at 3% to 6% of collections.
Codes and modifiers on a chiropractic claim
Medicare rules unless noted. Commercial plans and Medicaid set their own.
- 98940, 98941, 98942Spinal CMT for one to two, three to four, or five regions. The only chiropractic services Medicare pays.
- 98943Extraspinal CMT: head, extremities, rib cage or abdomen. Not covered by Medicare; Aetna, for one, covers it when its criteria are met.
- AT modifierActive or corrective care of an acute or chronic subluxation. Medicare treats CMT without it as maintenance and denies it.
- GA modifierA signed ABN is on file because Medicare is expected to deny the visit as not reasonable and necessary.
- GY and GXGY marks a service Medicare excludes, such as an exam or x-ray by a chiropractor. GX shows a voluntary notice was given.
- GZ modifierDenial expected and no ABN. Medicare denies the line automatically, and without the notice you may be liable.
- Diagnosis orderThe subluxation, with its spinal level, first (such as M99.03, lumbar), then the neuromusculoskeletal condition.
- Start-of-care dateThe date the course of treatment began, required on every Medicare chiropractic claim.
Active care or maintenance: where Medicare draws the line
Care is active when it treats a new injury (acute) or a long-standing problem still expected to improve in function (chronic). Once the patient’s status is stable and no further objective improvement is expected, more manipulation is maintenance therapy, which Medicare does not cover. CMS’s guidance on the AT modifier says to leave AT off maintenance visits, and notes a 41 percent error rate for chiropractic claims in 2018, mostly from documentation.
For maintenance care you expect Medicare to deny, the patient signs an ABN before the visit and the claim carries GA, so you can bill the patient after the denial. Contractors differ on AT and GA together: Palmetto GBA rejects lines with both, while WPS’s chiropractic billing article says to add GA with AT when an active-care visit is likely to be denied. We follow your contractor’s written instruction.
Documentation that supports the claim: PART and the plan
Medicare accepts a subluxation shown by an x-ray taken up to 12 months before or 3 months after care starts, or by a physical exam. The exam must find two of the four PART findings, and one of them must be asymmetry or range of motion:
- Pain or tenderness, by location, quality and intensity
- Asymmetry or misalignment at a sectional or segmental level
- Range of motion abnormality
- Tissue or tone changes in the nearby soft tissue
The first visit also needs the history, the diagnosis with the level of subluxation, and a treatment plan with frequency and duration, goals and objective measures. Each later visit records an exam of the spinal area, the change since the last visit and the treatment given. We check these before a claim is sent.
Commercial plans and Medicaid
Commercial plans write their own chiropractic policies, and some cover more than Medicare. Aetna’s chiropractic policy, for example, covers extraspinal manipulation with the spinal codes when its criteria are met, and expects improvement to be documented within the first 2 weeks of care. Whether a plan pays for the exam, x-rays or therapy codes, and how many visits, depends on the plan and the patient’s benefits, so we check before the first visit.
Where a payer follows NCCI and pays chiropractors for therapy codes, the NCCI policy manual bars neuromuscular reeducation (97112), massage (97124) and manual therapy (97140) in a region that got CMT that day; in a different region, modifier 59 or XS applies. Medicaid coverage of chiropractic is an optional benefit, so it depends on the state.
Why chiropractic claims deny
Common reasons, with the reason codes that often carry them (codes vary by payer):
- CMT billed to Medicare without AT, read as maintenance (CO-50)
- Subluxation not listed first, or no spinal level (CO-11)
- Exams, x-rays or 98943 sent to Medicare, denied as non-covered (CO-96)
- A therapy code in the same region as CMT (CO-97 or CO-236)
- A plan’s visit limit reached, or no authorization (CO-119 or CO-197)
Each one goes through our denial management process, and our denial code guides explain what each code means. When a secondary plan needs a Medicare denial for an excluded service, we bill it with GY.
How we run chiropractic billing
Verify benefits first
Medicare status, commercial chiropractic benefits, visit limits and authorization rules are checked before the first visit.
Sort active from maintenance
Each Medicare visit is checked for AT, or for an ABN and GA, against the treatment plan and the latest exam.
Code from the note
Regions treated, diagnosis order, the start-of-care date and same-day therapy edits are checked before the claim goes out.
Bill the patient correctly
Maintenance visits go to the patient only with a signed ABN on file, and excluded services with the reason shown.
Report monthly
Collections, days in A/R, denials by reason and patient balances, by payer and by provider.
Credentialing for chiropractors
Chiropractors cannot opt out of Medicare, so a practice that treats Medicare patients enrolls. Some commercial plans credential chiropractors through a separate company: UnitedHealthcare’s credentialing FAQ sends them to OptumHealth Physical Health. Our provider credentialing service handles Medicare and those networks, from $189 per payer application.
Only manual manipulation of the spine to correct a subluxation, billed with 98940, 98941 or 98942 and the AT modifier when care is active or corrective. Medicare does not pay for anything else a chiropractor furnishes or orders, including exams, x-rays, therapies and extraspinal manipulation (98943). Maintenance care, once the patient has stopped improving, is not covered either.
AT tells Medicare the manipulation is active or corrective treatment of an acute or chronic subluxation. Without it, Medicare treats the visit as maintenance and denies it. With it, the record still has to show the patient is improving: AT does not guarantee payment, and contractors can deny after medical review.
Before any visit you expect Medicare to deny as not reasonable and necessary, which is usually maintenance care. The patient signs the ABN before the service, the claim carries the GA modifier, and you can bill the patient after Medicare denies. For excluded services such as exams and x-rays, a notice is voluntary, and GY or GX applies.
PART stands for pain or tenderness, asymmetry or misalignment, range of motion abnormality, and tissue or tone changes. To show a subluxation by physical exam, Medicare needs two of the four, and one must be asymmetry or range of motion. Each later visit then needs an exam of the spinal area treated and the change since the last visit.
Some do, and it varies by plan. Aetna’s policy, for example, covers extraspinal manipulation (98943) when its criteria are met. Coverage of exams, x-rays and therapy codes, visit limits and authorization rules differ by plan and by the patient’s benefits, so we verify them before the first visit and bill each plan to its own policy.
Our full-service rate is 3% to 6% of monthly collections, set by your volume, with no setup or onboarding fees and flexible monthly-minimum plans for new and smaller practices. It covers eligibility checks, prior authorizations, coding, claims, payment posting, denials and A/R follow-up, plus modifier checks, ABN tracking and patient statements. Your exact rate comes after a free A/R review. Our guide to medical billing costs shows how to compare quotes.
Yes. We don’t list our clients on this site, but ask us and we’ll arrange it: with a current client’s permission, we share their contact details so you can hear how we work from them directly.
From our guides
How to calculate days in A/R
The formula with a worked example and a calculator, the benchmarks, why a good average can hide old claims, and the fixes that bring days in A/R down.
How much do medical billing services cost?
The four ways billing companies price their work, the fees that sit outside the rate, and in-house arithmetic built from BLS data, so you can compare quotes on your own numbers.
Send us your last 90 days of chiropractic claims.
We’ll review them free and show you where modifiers, ABNs or documentation are costing you money.