Chiropractic Billing Services
Chiropractic billing can feel confusing, time-consuming, and stressful—but it doesn’t have to be. That’s exactly where we come in. With our specialized Chiropractic Billing Services, we make your entire billing process simple, accurate, and fast.
We handle coding, claim submissions, insurance follow-ups, and payment posting, so you can focus fully on your patients instead of paperwork. Our team understands the unique challenges chiropractors face, and we use smart strategies to help you reduce errors, cut down denials, and improve cash flow.
When you work with us, you get reliable support, clear communication, and a smooth revenue cycle. Let us take care of your billing while you take care of your patients.
Chiropractic Payer Rules We Manage
Chiropractors bill Medicare, commercial plans, benefit managers and injury carriers, each with its own rules. These are the payer rules our revenue cycle management team handles beyond the codes:
Chiropractic benefit managers
What it means: Many health plans hand chiropractic benefits to a separate benefit manager that sets visit limits and requires authorization after the first visits.
How we handle it: We find out who manages each patient’s chiropractic benefit, request visits before they are used, and track how many remain.
Manual therapy with manipulation
What it means: Manual therapy (97140) on the same region as spinal manipulation is part of the manipulation and is denied. It is paid only on a separate region, with modifier 59 or XS.
How we handle it: We check that the note shows a different region for manual therapy, and leave it off when it doesn’t.
Office visits with manipulation
What it means: Manipulation includes a brief check before the treatment. A separate visit (E/M) is paid only for a new problem, a new injury or a formal re-exam, with modifier 25.
How we handle it: We bill the visit only when the note supports separate work, and add modifier 25 when it does.
Medicare X-ray rules
What it means: Medicare doesn’t pay chiropractors for X-rays. If an X-ray is used to show a subluxation, it must be taken within 12 months before or 3 months after treatment starts.
How we handle it: We check the X-ray date when it is used as proof, and rely on the physical exam (PART) when it is not.
Medicare participation
What it means: Chiropractors can’t opt out of Medicare. They must submit claims for covered manipulation for Medicare patients, as participating or non-participating providers.
How we handle it: We confirm your enrollment status and bill Medicare for every covered visit, with the right fee limits for non-participating providers.
Personal injury and auto claims
What it means: Car accident and personal injury patients are billed to the auto carrier or held against a settlement under a lien, before their health plan pays.
How we handle it: We collect the claim and attorney details at intake, bill the right carrier first, and track balances held on liens.
A Common Chiropractic Denial and How We Fix It
Example: manual therapy denied with spinal manipulation
The denial. Spinal manipulation of three regions (98941) and manual therapy (97140) are billed for the same visit. Manual therapy is denied with CARC 236 (this procedure isn’t compatible with another procedure on the same day under NCCI edits).
How we fix it:
- Check the regions. We compare the regions manipulated with the region where manual therapy was done.
- Correct and resubmit. If manual therapy was on a separate region, we resubmit with modifier 59 or XS and the diagnosis for that region.
- Leave it off when it overlaps. If it was on a manipulated region, it isn’t billed separately.
- Prevent the next one. We check regions on every visit with both services before the claim goes out.
Example: Medicare manipulation denied as maintenance care
The denial. Medicare denies spinal manipulation (98940) with CARC 50 (not medically necessary) because the record shows no improvement, so the care is considered maintenance.
How we fix it: if the treatment plan shows measurable goals and progress, our denial management team appeals with the plan and the visit notes. If the care was maintenance, Medicare won’t pay, and the patient is responsible only when an ABN was signed before the visit and the claim carried modifier GA. Going forward, we check for a current treatment plan and the AT modifier on every Medicare visit.
Why Choose Chiropractic Billing Services?
Be aware of Billing Rules
We are fully acquainted with the rules of chiropractic billing, and our staff is informed on how to deal with codes, modifiers, and the requirement of documentation. Our billing is simple and smooth for your practice. In our company, you remain on course and minimize mistakes, and enhance your working routine.
Reduce Claim Denials
We also carefully work on all claims to minimize denials and delays. All details are verified before submission to our team, and hence, insurance companies accept your claims more quickly. Our structured procedure helps you to lose less money, have fewer issues, and maintain your chiropractic revenue cycle.
Maximize Your Refunds
We employ correct coding, claim submission, and effective follow-up to enhance your reimbursements. We have professionals who monitor the payments, resolve problems in a short period, and ensure that you get the right money. Our assistance allows your income to increase, and your practice to have a more secure future financially.
Billing in a Way You Like to Focus on Patients
The entire process of billing is under our care, and you remain at liberty to attend to the patients. Our group does the coding, claims, follow-ups, and reports. This will save you time and ease your stress level, and will enable your practice to run without disturbance and paperwork pressure.
Provide Open Accounting
Our reports are very straightforward and clear, and you will always know what is going on with your billing. We have a reporting system displaying payments, claim status, denied claims, and trends. Through such transparency, you make higher-quality choices, and you strategize your chiropractic services.
Keep abreast with Industry changes
We maintain new rules of insurance, new codes, and new healthcare rules. Your billing process is changed within a short period of time by our team when there are new requirements. Using our current expertise, your chiropractic business remains on top and does not make any expensive errors or waste time with outdated data.
Chiropractic Manipulation Codes and Medicare Active Treatment Rules
Chiropractic billing is defined by Medicare's narrow coverage rules for spinal manipulation and the documentation they require.
| Service | Codes and rules | What we check |
|---|---|---|
| Spinal manipulation | 98940 (1–2 regions), 98941 (3–4), 98942 (5 regions) | Regions treated match the code and the diagnoses |
| Extraspinal manipulation | 98943 | Medicare does not cover it, so patients are told in advance |
| Medicare active treatment | Modifier AT on manipulation that is expected to improve the patient's condition | A treatment plan with goals and progress is documented |
| Maintenance care | Not covered by Medicare; an ABN is signed and modifier GA is added | The ABN is on file before the service |
| Documentation (PART) | Pain, asymmetry or misalignment, range of motion changes and tissue changes, with subluxation shown by exam or X-ray | At least two PART elements, one being asymmetry or range of motion, support each visit |
| Other services | Exams and therapy codes billed to commercial plans that cover them | Each plan's visit limits and coverage are checked |
Chiropractic Billing FAQs
What does Medicare cover for chiropractors?
Only manual manipulation of the spine to correct a subluxation (98940–98942). Exams, X-rays and therapies ordered by a chiropractor are not covered.
What is the AT modifier?
It shows that manipulation is active treatment expected to improve the condition. Without it, Medicare treats the service as maintenance care and denies it.
How should maintenance care be billed to Medicare?
The patient signs an Advance Beneficiary Notice before the visit, and the claim is sent with modifier GA so the patient can be billed after the denial.
Get in Touch with us.
Prospect Healthcare Solutions is the place where you can find help in making your practice run smoothly and improve your chiropractic billing.
Our team will be happy to respond to your inquiries, to show you around our services, and to discuss with you how our billing solutions can improve your revenue cycle. We hear you and provide the appropriate assistance to your practice. Contact us at any time to learn more or apply for our professional chiropractic billing services.
We can offer full billing management or assistance in particular tasks, so that you do not have to think about such issues anymore. Call us and let Prospect Healthcare Solutions handle the financial side, so you can continue to provide high-quality care to patients. We can be contacted anytime via a call or a message.
Prefer to talk? Call +1 (469) 935-4617 or visit our contact page.