Chiropractic billing
Chiropractic billing,
without the denials.
Chiropractic is one of the most scrutinized specialties in billing. Medicare covers a narrow set of services and expects specific documentation. We make sure what you bill matches what you documented and what the payer covers.
What makes it hard
Where chiropractic revenue gets lost.
Narrow Medicare coverage
Medicare covers manual manipulation of the spine to correct a subluxation (CPT 98940 to 98942) and generally not exams, therapies or maintenance care performed by chiropractors.
Active vs maintenance care
Active treatment needs the AT modifier. Maintenance care is not covered by Medicare and needs an Advance Beneficiary Notice if you intend to bill the patient.
Documentation
Records must support the subluxation and the treatment plan. Missing elements are a common reason for denials and recoupments.
Commercial plan limits
Commercial plans often limit visits per year, require authorizations, or route chiropractic benefits through a separate network.
How we handle it
Checks built into every claim.
Our team and the GetMax platform apply these checks before claims go out, not after the denial comes back.
- Coverage checked per payer before the first visit, including visit limits
- AT, GA and GZ modifiers applied according to the care plan and ABN status
- Documentation prompts so visit notes support the codes billed
- Patient responsibility for non-covered services explained upfront
Frequently asked
Questions we hear a lot.
Does Medicare pay for chiropractic exams?
Generally no. Medicare covers chiropractors' manual manipulation of the spine for subluxation. Exams and other services are typically the patient's responsibility, and an ABN may be needed.
When is an ABN required?
When you expect Medicare to deny a service as not medically necessary, such as maintenance care, and you want to be able to bill the patient for it.
Keep reading
Other specialties.
Specialty
Behavioral & mental health
Billing for therapists, psychiatrists and counseling groups: time-based psychotherapy codes, telehealth, authorizations and carve-out payers, handled.
Learn more →Specialty
Physical therapy
PT billing that gets timed units, the 8-minute rule, KX thresholds, plan-of-care certification and visit limits right, so therapy claims get paid.
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Primary care
High-volume primary care billing: preventive and problem visits, modifier 25, wellness visits, chronic care management and fast eligibility checks.
Learn more →Let's look at your chiropractic numbers.
Tell us your payer mix and your biggest headache. We will show you what we would change.