Why Chiropractic Billing is different

Chiropractic billing looks simple on the surface, you treat a patient, you submit a claim but the reality is nuanced. Medicare and many commercial payers limit coverage (manual spinal manipulation is a limited Medicare benefit), CPT code rules and modifiers (for example, the AT modifier and the set of CMT codes) require precise documentation, and a single miscoded or undocumented visit can turn into a denial or write-off. Clear coding (98940 – 98942 for spinal CMT; 98943 is extraspinal and may not be covered by Medicare), appropriate use of modifiers, and tightly managed claim follow-up are the difference between on-time payment and long accounts receivable.

Common CPT codes used by Chiropractors

The core components of chiropractic billing

1. Accurate coding — Use the right CMT codes (98940, 98941, 98942) and bill adjunct services (E&M, therapeutic modalities) correctly. Improper code selection is a top denial source.
2. Modifier rules & documentation — Example: Medicare requires an AT modifier for active/corrective treatment in certain cases and rejects claims that lack appropriate modifiers or documentation.
3. Insurance verification & eligibility — Verifying benefits up front prevents surprises and underpayments.
4. Claims submission & clearinghouse management — Clean claims get paid faster; specialized clearinghouse setup for chiropractic CPT/HCPCS helps.
5. Denial management & appeals — Successful appeals and denial prevention boost net collections.
6. Patient statements & collections — Patient balances are rising industry-wide; clear statements and payment plans are essential.

Common billing pitfalls

• Pitfall: Using 98942 when documentation only supports 1–2 regions.
  Fix: Train clinicians on region counts and require brief chart notes indicating which regions were adjusted.
• Pitfall: Wrong modifier usage (or missing AT modifier for Medicare).
  Fix: Create a modifier checklist in the EHR front desk workflow.
• Pitfall: No verification of patient’s out-of-network benefits.
  Fix: Verify benefits at check-in and document copay/coinsurance and prior authorizations where required.

In-House vs. Outsourced Billing | Comparison

How MediDocCareMD Helps Chiropractic Practices

MediDocCareMD specialize in RCM for small-to-medium healthcare practices, including chiropractors. Here’s how we deliver measurable results:

• Chiropractic-specialist coding team: Coders trained in CMT (98940–98942), E/M integration, and modifier rules to cut down front-end denials.
• Eligibility & benefits verification: We verify patient benefits before visit and document payer rules (including PT/OT/E&M overlaps) to reduce rejections.
• Clean claim submission: Claims scrubbed against top payer edits and submitted through high-throughput clearinghouses for faster adjudication.
• Denials & appeals program: Proactive denial prevention plus a dedicated appeals team to recover underpaid/denied claims. Industry benchmarks show outsourced specialists can increase net collections substantially (many firms report collection lifts and faster payment cycles).
• Transparent reporting: Weekly KPI dashboards (collections, AR days, denial reason breakdown) so you can see progress.
• Seamless EHR integration: We work with common chiropractic EHRs and practice systems (ChiroTouch, DrChrono, Genesis, Kareo, etc.) to keep workflows smooth.

Value proposition: We handle the billing so providers can focus on patient care  with pricing that aligns to your collections and a fast onboarding process.

MediDocCareMD can run a free 30-point billing audit on a sample of your recent claims (no charge) to show where revenue is being lost and how much we can recover.
Email us or schedule a demo to see our chiropractic-specific KPI dashboard.