Chiropractic Medical Billing Services

Chiropractic billing comes with challenges that make it more complex than standard medical billing. Reimbursement for chiropractic services is heavily regulated by Medicare and commercial payers, with strict limits on covered services, visit frequency, and documentation requirements. To be reimbursed, chiropractic care must meet medical necessity standards and be classified as active treatment, while maintenance care is typically non-covered.

Payments for chiropractic services are primarily linked to spinal manipulation CPT codes 98940–98942, with additional scrutiny applied to therapy modalities, diagnostic tests, and extraspinal adjustments. Correct use of modifiers such as AT, GA, GY, and GZ is required to differentiate between active care, non-covered services, and patient-liable services. Errors in modifier application, incomplete SOAP notes, or failure to link ICD-10 subluxation codes (M99.01–M99.09) to treatment are leading causes of denials and audit risk.

Through its chiropractic billing services, MZ Medical Billing helps practices increase collections by 10–15% and reduce denials by 25–35%. By applying accurate CPT and ICD-10 codes, managing modifier use, and following payer rules, our billing specialists keep chiropractic claims compliant with Medicare, Medicaid, and commercial insurance requirements while supporting faster reimbursements and stronger revenue.

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Chiropractic Billing Services You Can Trust

Chiropractic billing is one of the most closely regulated areas of healthcare reimbursement. Unlike other specialties, chiropractic claims are limited in scope, with Medicare and commercial payers covering only specific spinal manipulation procedures (CPT 98940–98942) when linked to a subluxation diagnosis (ICD-10 M99.01–M99.09). Modifier use, such as AT for active treatment or GA/GY/GZ when an ABN applies, is critical to distinguish covered services from non-covered maintenance care. Errors in documentation, diagnosis linkage, or modifier application often result in denials, underpayments, or post-payment audits.

MZ Medical Billing provides chiropractors and chiropractic groups with a complete suite of billing and revenue cycle solutions designed to improve collections while keeping practices compliant with Medicare, Medicaid, and commercial payer requirements.

Medical Billing Services

We handle the full chiropractic billing cycle, charge entry, claim submission, and payer follow-up. Chiropractic services are billed under CPT codes 98940–98942 (spinal manipulation) and 98943 (extraspinal manipulation), as well as therapy and exam codes when applicable. Each claim must include a subluxation diagnosis (ICD-10 M99.01–M99.09) and the correct modifier. Our medical billing service applies payer rules to reduce denials and payment delays.

Medical Coding Services

Our certified coders focus on chiropractic-specific codes, including spinal manipulation (98940–98943), therapy codes (97110, 97112, 97140), and evaluation/management services. We as a medical coding service apply the AT modifier for active treatment and GA, GY, or GZ when an ABN is required. Correct coding with diagnosis linkage and modifier use is critical for reimbursement.

Provider Credentialing Services

Delays in credentialing stop chiropractors from billing payers. We manage enrollment with Medicare, Medicaid, and commercial insurance carriers, update CAQH profiles, and keep provider information current so practices stay active with insurance panels.

Practice Audit Services

Chiropractic claims are closely reviewed by payers. We audit SOAP notes, diagnosis codes, modifier use, and claim history to identify missed revenue, improper coding, or compliance risks. Audits help recover revenue and prepare practices for payer reviews.

Revenue Cycle Management (RCM)

We manage the chiropractic revenue cycle from eligibility verification through payment posting. This includes monitoring visit frequency, applying LCD rules, managing therapy caps, and reducing denials. Strong A/R control keeps revenue moving and prevents backlogs.

Insurance Verification Services

Chiropractic coverage varies widely by payer. We verify benefits, visit limits, deductibles, and copays before services are rendered, which reduces claim rejections and gives patients clarity about out-of-pocket costs.

Prior Authorization Services

Some chiropractic-related services, such as therapy, rehab, or diagnostic imaging, require prior authorization. We prepare and submit documentation, obtain approvals, and monitor requests to avoid treatment delays.

Denial Management

Chiropractic denials are often linked to missing AT modifiers, exceeding visit caps, or lack of medical necessity documentation. We correct claim errors, file appeals, and recover payments that would otherwise be lost.

Payment Posting

Chiropractic billing includes multiple service lines, from spinal adjustments to therapy and exams. We post payments accurately, reconcile with payer remittances, and flag underpayments for follow-up.

Accounts Receivable (AR) Recovery

Outstanding chiropractic claims grow quickly due to strict payer policies. We pursue unpaid claims, resolve disputes, and appeal denied charges to bring in delayed revenue.

Telehealth Billing

Chiropractors are increasingly billing for telehealth services such as consults, exercise instruction, and lifestyle counseling. We apply the correct place-of-service codes (02, 10) and modifiers (95, GT) for eligible claims.

Patient Billing Services

Patients often misunderstand coverage rules for chiropractic care. We provide clear billing statements, payment plan options, and responsive support to improve collections.

Practice Management Services

We assist chiropractic offices with scheduling oversight, payer mix tracking, denial trend analysis, and productivity reporting to strengthen financial performance.

Old AR Cleanup

Chiropractic practices often carry aging A/R due to coding issues, missing AT modifiers, or documentation gaps. We review unpaid claims, fix errors, and recover revenue from older accounts.

Appeals and Disputes Management

Chiropractic services frequently face denials as “maintenance care.” We prepare detailed appeals with treatment notes, coding justification, and supporting records to overturn denials and secure payment.

Why Chiropractic Billing Is Different

Unlike most medical specialties, chiropractic billing is restricted by strict payer rules, limited covered codes, and detailed documentation requirements. Chiropractic reimbursement is not based on a broad range of procedures but instead tied to a small set of spinal manipulation codes and related therapy services.

Key factors that make chiropractic billing unique:

Limited CPT Codes: The core chiropractic services are spinal manipulation codes 98940 (1–2 regions), 98941 (3–4 regions), and 98942 (5 regions), with 98943 for extraspinal manipulation. Most other services are either non-covered or heavily restricted.

ICD-10 Subluxation Codes: To qualify for reimbursement, claims must include a subluxation diagnosis (M99.01–M99.09) linked to the spinal region being treated. Without it, payers deny the claim.

AT Modifier: Medicare requires the AT modifier on chiropractic claims to show that care is active treatment, not maintenance. Claims without this modifier are automatically denied.

Frequency Limits: Many payers impose visit caps (e.g., 12–20 visits per year). Services beyond these limits require additional documentation or prior authorization.

Maintenance vs. Active Care: Only active corrective treatment is covered. Maintenance care is almost always denied, even if clinically beneficial. Documentation must clearly support medical necessity and patient progress.

ABN and Non-Covered Services: Chiropractors often provide services not covered by insurance (e.g., massage therapy, certain modalities). Correct use of ABNs (Advance Beneficiary Notices) and modifiers (GA, GY, GZ) determines whether patients or payers are responsible for payment.

Because of these rules, chiropractic billing is highly vulnerable to denials if coding, modifier use, or documentation is incomplete.

Chiropractic Billing Compliance

Chiropractic billing compliance is governed by strict Medicare and commercial payer rules. Reimbursement depends on correct CPT coding, proper modifier use, and documentation that clearly supports medical necessity.

Key compliance factors include:

CPT Codes: Chiropractic care is limited to spinal manipulation codes:
- 98940 – Manipulation, 1–2 regions
- 98941 – Manipulation, 3–4 regions
- 98942 – Manipulation, 5 regions
- 98943 – Extraspinal regions (not always covered)
ICD-10 Subluxation Codes: Claims must link manipulation codes to the correct subluxation diagnosis (M99.01–M99.09) matching the treated region.
AT Modifier: Required on Medicare claims to show treatment is active/corrective care. Claims submitted without the AT modifier are automatically denied.
GA, GY, GZ Modifiers: Used for non-covered or maintenance care when issuing an ABN (Advance Beneficiary Notice). These determine whether the patient or insurer is responsible for payment.
Active vs. Maintenance Care: Only active treatment aimed at improving function is reimbursable. Maintenance or wellness care is not covered, even if clinically recommended.
Documentation Standards: Records must include the patient’s condition, treatment plan, progress notes, and evidence that care is active. Missing elements can result in claim denials or post-payment audits.

MZ Medical Billing applies the correct chiropractic modifiers, links procedures with subluxation codes, and tracks payer-specific rules to keep claims compliant and reimbursable.

The Experts in Maximizing Chiropractic Revenue

98% Clean Claims Rate
MZ Billing achieve a 98% clean claims rate by applying chiropractic-specific coding audits, precise modifier use (AT, GA, GY, GZ), and payer-specific edits before submission. This minimizes denials and accelerates payments, so chiropractors receive reimbursement without unnecessary delays.
Expert Team for Chiropractic Billing
Our team includes AAPC-certified coders and chiropractic billing specialists with 10+ years of experience. We manage spinal manipulation coding (98940–98942), ICD-10 subluxation linkage (M99.01–M99.09), and Medicare documentation requirements daily—helping chiropractors prevent revenue loss.
Tools Made for Chiropractic Billing
We use chiropractic-focused billing software integrated with EHR systems. These tools link subluxation diagnoses with spinal manipulation codes automatically, apply the correct modifiers, and flag non-covered services, reducing errors and improving payment accuracy.
Full Revenue Cycle Support
From credentialing and payer enrollment to claim submission, appeals, and patient billing, we manage the entire chiropractic revenue cycle. Our services cover solo practitioners, multi-provider chiropractic groups, and integrated practices offering physical therapy or rehabilitation.
Compliance Without Risk
Our billing process follows CMS chiropractic guidelines and commercial payer rules. Regular audits identify issues like missing AT modifiers, incorrect subluxation coding, or billing maintenance care as active care, reducing audit risk and protecting revenue.
Clear Data and Reports
We provide monthly customized reports showing CPT utilization (98940–98943), modifier usage, denial trends, payer performance, and financial results. This gives practices complete visibility into collections and reimbursement patterns.
Quick Payments – Less than 30 Days in A/R
While the national average for chiropractic A/R is 35–40 days, our clients consistently achieve under 28 days in A/R. Faster payments improve practice cash flow and reduce collection delays.
Higher Revenue – 10–15% More
Our chiropractic clients see 10–15% higher net collections compared to in-house billing. This comes from accurate coding, reducing denial rates to below 5%, and applying payer-specific chiropractic rules that maximize reimbursement.

Complexities in Chiropractic Billing

Chiropractic billing comes with its own unique challenges. Between Medicare’s strict guidelines, private payer variability, and documentation requirements for subluxation and active treatment, practices face frequent denials if billing is not managed correctly. Below are the main complexities that make chiropractic billing a specialized area of medical reimbursement.

Unique Billing Rules

Chiropractic billing centers around CPT codes for spinal manipulation (98940–98942) linked directly to a documented subluxation diagnosis (ICD-10 codes M99.01–M99.09). Claims without a properly linked subluxation are automatically denied by Medicare and many commercial payers.

Active Treatment vs. Maintenance Care

Medicare only reimburses for active treatment—care aimed at improving or correcting a condition. Maintenance therapy for chronic pain, wellness, or prevention is non-covered. Billing maintenance care as active treatment is a leading cause of audits and recoupments.

Modifier Usage

Correct modifier use (AT for active treatment, GA/GY/GZ for non-covered services) is essential. Missing or incorrect modifiers can cause denials, patient billing disputes, or compliance violations.

Documentation Requirements

Chiropractors must document the subluxation, treatment plan, goals, and progress notes for every visit. Insufficient documentation leads directly to non-payment, particularly for Medicare and Medicaid claims.

Medicare Complexity

Medicare requires a specific diagnosis of subluxation, proof of medical necessity, and consistent use of the AT modifier. Errors in any of these areas lead to denials or refund requests after audits.

Prior Authorization Challenges

Some commercial payers and Medicaid programs require prior authorization for chiropractic visits beyond a set limit (e.g., 12 visits). Missing or delayed authorizations result in denied claims.

Visit Caps and Payer Limits

Many payers impose visit limits per year or per condition. Billing beyond these caps without medical review notes or exceptions is a common reason for denied reimbursement.

Non-Covered Services

Services like exams, x-rays, therapy modalities (ultrasound, electrical stimulation), or massage therapy may not be covered under certain plans. Practices must separate billable vs. non-billable services clearly to avoid compliance issues.

Bundling Issues

Chiropractic services sometimes bundle with physical therapy or rehabilitation. Billing these together requires careful coding to prevent denials for “duplicate” or “inclusive” services.

Commercial Payer Variability

Every insurance carrier has its own chiropractic coverage rules. Some cover manipulation only, while others reimburse limited modalities. Keeping track of payer-specific edits is critical to prevent recurring denials.

Audit Risk

Chiropractic billing is frequently audited by Medicare and commercial insurers due to high denial rates. Common triggers include excessive visits, billing maintenance care, and poor documentation.

Patient Billing Sensitivity

Patients often expect chiropractic care to be fully covered. When services are denied as maintenance or non-covered, billing disputes arise unless practices use proper ABNs (Advance Beneficiary Notices) and clear patient communication.

Accounts Receivable Challenges

Because of recurring denials and non-covered services, chiropractic practices often carry high A/R balances. Without aggressive follow-up and appeals, revenue leakage becomes significant.

Coding in Chiropractic Billing

Accurate coding is the foundation of successful chiropractic billing. Unlike other specialties, chiropractic billing is restricted to a limited set of CPT codes, tied directly to spinal subluxation diagnoses, with strict Medicare and payer-specific requirements. At MZ Medical Billing, our certified coders specialize in chiropractic CPT, ICD-10, and modifier application to maintain compliance and optimize reimbursement.

CPT Codes for Chiropractic Services

Chiropractic procedures primarily fall under the CPT code range 98940–98943, which covers spinal and extraspinal manipulative treatment:

98940 – Chiropractic manipulative treatment (CMT); spinal, 1–2 regions
98941 – CMT; spinal, 3–4 regions
98942 – CMT; spinal, 5 regions
98943 – CMT; extraspinal, 1 or more regions (e.g., extremities)

In addition, chiropractors may bill for evaluation and management (E/M) services when medically necessary and separately identifiable, though these are closely monitored for compliance. Therapy modalities (97010–97140), x-rays, and exams may also be reported, but coverage varies widely by payer.

ICD-10 Codes for Chiropractic Services

Chiropractic billing requires linking CMT codes to subluxation diagnoses. Medicare and most commercial insurers only reimburse manipulative services when paired with valid M99 subluxation codes, such as:

M99.01 – Segmental and somatic dysfunction of the cervical region
M99.02 – Segmental and somatic dysfunction of the thoracic region
M99.03 – Segmental and somatic dysfunction of the lumbar region
M99.04 – Segmental and somatic dysfunction of the sacral region
M99.05 – Segmental and somatic dysfunction of the pelvic region

Supporting ICD-10 codes for conditions such as M54.2 (cervicalgia) or M54.5 (low back pain) may be included, but a valid M99 code must be present for Medicare compliance.

Modifiers in Chiropractic Billing

Modifier use is essential in chiropractic billing to distinguish between active treatment, non-covered services, and compliance with payer rules:

AT – Active treatment (required by Medicare for all covered chiropractic manipulations)
GA – Waiver of liability statement issued as required by payer policy (ABN on file)
GY – Item or service statutorily excluded or not a Medicare benefit
GZ – Item or service expected to be denied as not reasonable or necessary (no ABN issued)
25 – Significant, separately identifiable E/M service on the same day as manipulation

Without the proper modifier, even medically necessary services are denied or flagged for audit.

Chiropractic Billing & RCM Services for Practices Nationwide

MZ Medical Billing provides specialized chiropractic billing and Revenue Cycle Management (RCM) services to practices across the United States. We work with solo chiropractors, multi-provider clinics, and multidisciplinary practices to improve reimbursements, reduce denials, and maintain steady cash flow.

Our billing team manages payer requirements, Medicare’s “active treatment” rules, chiropractic coverage limitations, therapy service guidelines, and documentation demands. From initial exams and diagnostic imaging to chiropractic manipulative treatment (CMT) and therapeutic modalities, we handle the complexity of chiropractic claims with precision.

With MZ Medical Billing, chiropractic practices gain accurate claims submission, faster reimbursements, and financial stability—allowing providers to focus on patient care while we manage compliance and revenue integrity.

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Medical Billing Services for Chiropractic and Other Specialties

Our chiropractic billing experts provide accurate, compliant, and efficient billing solutions for the unique demands of chiropractic practices. From spinal manipulation (CMT) and extraspinal adjustments to therapy modalities, exams, and diagnostic imaging, we deliver specialty-specific coding, precise claim submission, and full revenue cycle management to keep reimbursements consistent.

In addition to chiropractic, we support multiple healthcare specialties, including orthopedics, cardiology, physical therapy, occupational therapy, speech therapy, mental health, family medicine, and dermatology—giving every provider reliable billing solutions adapted to their practice.

Applied Behavior Analysis

Behavioural Health

Pediatric

Mental Health

Physical Therapy

Occupational Therapy

Speech Therapy

Anesthesiology

MZ Medical Billing Can Work with Any Chiropractic Billing Software

FAQS

Frequently Ask Questions.

What makes chiropractic billing different from other specialties?

Chiropractic billing is unique because Medicare and most commercial payers only reimburse manipulative treatment when linked to a spinal subluxation diagnosis (ICD-10 M99 series). Claims must also include the AT modifier to show active treatment, making compliance more complex than in other fields.

Which CPT codes are most commonly used in chiropractic billing?

The primary chiropractic CPT codes are 98940–98943, which represent spinal and extraspinal manipulative treatment (CMT). Chiropractors may also bill for exams, therapy modalities, and imaging when medically necessary and covered by the payer.

Why do chiropractic claims often get denied?

The most common denial reasons include:

Missing or incorrect M99 subluxation codes
Not using the AT modifier when required by Medicare
Billing for maintenance therapy instead of active treatment
Insufficient documentation of medical necessity

Can chiropractors bill Medicare for maintenance therapy?

No. Medicare only covers chiropractic manipulative treatment when it is active treatment aimed at correcting a subluxation. Maintenance therapy (for long-term wellness or preventive care) is not reimbursed and must be billed directly to the patient.

Do chiropractic practices need prior authorizations?

Some commercial payers require prior authorization for chiropractic visits after a certain limit or for therapy services beyond CMT. Medicare does not require prior authorization, but strict documentation of subluxation and treatment necessity is mandatory.

What modifiers are important in chiropractic billing?

Key chiropractic modifiers include:

AT – Active treatment (required by Medicare)
GA, GY, GZ – For non-covered services with or without ABNs
25 – For significant, separately identifiable E/M services on the same day as manipulation

How does MZ Medical Billing help chiropractic practices?

We handle full revenue cycle management for chiropractors, including coding, claim submission, insurance verification, denial management, AR recovery, and compliance audits. Our team minimizes denials and accelerates reimbursements so chiropractors can focus on patient care.

How do you help with compliance and audit risk?

We follow the ASA Relative Value Guide, CMS guidelines, and payer-specific edits. Our internal audits check for missed time units, concurrency errors, and modifier misapplication, which reduces audit exposure and protects revenue.

Can you manage anesthesia billing nationwide?

Yes. MZ Medical Billing supports anesthesiology practices, CRNAs, and surgical centers in all 50 states, with expertise in both federal and state-specific payer rules.

What reporting do you provide anesthesia practices?