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
CPT Code | What it is | Notes |
98940 | CMT — spinal, 1–2 regions | Most commonly billed. Document regions. |
98941 | CMT — spinal, 3–4 regions | Use only when documentation supports 3–4 regions. |
98942 | CMT — spinal, 5 regions | Less common; use only with supporting documentation. |
98943 | CMT — extraspinal | Not a Medicare benefit (may be covered by some private insurers). |
97110 / 97112 / 97140 | Therapeutic exercises / NM re-ed / manual therapy | Billed when clinically distinct from CMT. |
The core components of chiropractic billing
- 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.
- 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.
- Insurance verification & eligibility — Verifying benefits up front prevents surprises and underpayments.
- Claims submission & clearinghouse management — Clean claims get paid faster; specialized clearinghouse setup for chiropractic CPT/HCPCS helps.
- Denial management & appeals — Successful appeals and denial prevention boost net collections.
- 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
Feature | In-House Billing | Outsourced Billing (generic) | MediDocCareMD (recommended) |
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Staffing costs | High (salaries + training) | Lower (pay per collection or flat fee) | Competitive pricing + specialist chiropractic RCM team (no training lag) |
Expertise in chiropractic CPT/modifiers | Varies | Specialist vendors often better | Dedicated chiropractic coders and denial experts — reduces denials |
Denial/appeal performance | Often reactive | Proactive appeal workflows | Proactive denials management, appeals, and AR follow-up tailored to chiro rules |
Technology & reporting | Dependent on practice EHR | Often includes advanced dashboards | Integrated dashboards + KPI reports (collections, DNFC, AR days) |
Scalability | Limited by staff | Easy to scale | Scales with practice growth; flat % or hybrid pricing options |
Compliance & security | Practice must manage | Vendor handles (should be HIPAA compliant) | HIPAA compliant, secure handling & regular audits |
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.
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