Chiropractic billing has more moving parts than its code count suggests. Medicare covers one service and denies the rest by statute. Commercial plans apply hard visit caps and medical necessity review. And for many practices the money is in personal injury and workers compensation, which most billing companies quietly avoid.
Our chiropractic billing services handle all of it. Practices comparing chiropractic medical billing services should ask specifically about PI, because billing for chiropractic services outside the insurance rails is where most of the difference shows up. If you are still joining networks, start with chiropractic credentialing services.
The codes
| CPT | Service | Note |
|---|---|---|
| 98940 | CMT, spinal, 1 to 2 regions | Medicare covered with AT modifier |
| 98941 | CMT, spinal, 3 to 4 regions | Most-billed code in most practices |
| 98942 | CMT, spinal, 5 regions | Audited; documentation must support all five |
| 98943 | CMT, extraspinal | Not covered by Medicare |
| 97110 / 97112 / 97140 | Therapeutic exercise, neuromuscular re-education, manual therapy | Timed codes; 59 or XS modifier often needed alongside CMT |
| 97012 / 97014 / 97035 | Traction, e-stim, ultrasound | Often bundled or non-covered |
| 99202 to 99215 | E/M visits | Needs modifier 25 when billed with CMT the same day |
The two modifiers that decide whether you get paid
AT tells Medicare the treatment is active, not maintenance. Without it a CMT claim is denied as maintenance care. Modifier 59 (or the more specific X-modifiers) separates a timed therapy code from the manipulation when both are performed in the same region, leave it off and the therapy is bundled into the CMT and paid at zero.
Medicare, maintenance care and ABNs
Medicare covers manual manipulation of the spine to correct a subluxation and nothing else a chiropractor does. Exams, x-rays and modalities are statutorily excluded.
That makes the ABN, the Advance Beneficiary Notice, the most valuable piece of paper in a chiropractic front office. Used correctly, it lets you bill the patient for maintenance care and for excluded services. Used late, or not at all, the practice absorbs the cost. We set up the ABN workflow and the GA and GY modifiers that go with it, so non-covered care is billable instead of written off.
Visit caps and medical necessity
Commercial chiropractic contracts, especially those administered by American Specialty Health or Optum Physical Health, carry visit limits and clinical review. Practices lose money by treating past the cap without knowing it.
- We track visits used against the plan's annual or per-episode limit and warn you before it is reached.
- We file the treatment plan or continued-care request the review requires, on time.
- We flag the documentation patterns that trigger review: identical daily notes, no measurable outcomes, no discharge planning.
Personal injury and workers compensation
This is where chiropractic differs most from other specialties, and where a general medical biller tends to fall over.
- Personal injury: billed against auto medical payments coverage or a third-party liability claim, frequently on a letter of protection, and settled long after the treatment. It needs lien tracking and attorney correspondence, not a claims clearinghouse. See personal injury billing.
- Workers compensation: state fee schedules, state-specific forms, prior authorization rules and an adjuster to chase. See workers compensation billing.
These balances age in months, not days, so they need a separate follow-up cadence from your commercial AR. We run them separately and report them separately.
What we do every week
- Eligibility and benefit checks, including the chiropractic visit cap and who administers the benefit.
- Charge entry and scrubbing with AT, 59/X and 25 modifiers applied correctly.
- Claim submission and clearinghouse rejection work.
- ABN workflow for Medicare maintenance and excluded services.
- Visit cap tracking and continued-care submissions.
- Denial management, including bundling and medical necessity appeals.
- PI and workers comp follow-up on their own cadence, with lien and adjuster tracking.
- Payment posting and underpayment checks against contracted and state fee schedules.
- Aged AR recovery across all four payer types.
Billing and credentialing together
- Joining networks?Chiropractic credentialing Medicare, ASH, Optum and workers comp panels.
- Rehab under the same roof?Physical therapy billing services the 8-minute rule and therapy thresholds.
Chiropractic billing FAQs
Why is Medicare denying my chiropractic claims?
The two usual reasons are a missing AT modifier, which makes the claim look like maintenance care, and billing a service Medicare excludes for chiropractors, exams, x-rays and modalities. The second is not an appeal; it is an ABN.
Why is my therapy code paying zero alongside the adjustment?
It is being bundled into the CMT. Timed therapy performed in a different region from the manipulation needs modifier 59 or the appropriate X-modifier, and the note has to support the separate region and service.
Do you handle personal injury billing?
Yes, including letters of protection, lien tracking and attorney correspondence. It is slower-paying work with a different follow-up rhythm, and we report it separately so it does not distort your AR figures.
How much do chiropractic billing services cost?
A percentage of collections for insurance work. PI and workers comp are usually quoted separately because the effort per dollar is different. You get the rate in writing before we start.
Can you bill patients for maintenance care legally?
For Medicare patients, yes, with a properly executed ABN signed before the service and the correct modifier on the claim. Doing it without the ABN is what causes refunds later.
Talk to a chiropractic biller
Send us a month of claims and your aged AR, including PI. We will tell you what is being bundled, what is being denied for maintenance, and what is recoverable.
Schedule a billing demo Talk to a billing expert