Chiropractic billing comes down to how many spinal regions were adjusted, which payer is paying, and whether the patient is still improving. The same three-region adjustment can be paid in full by a commercial plan, paid only with the AT modifier by Medicare, or denied as maintenance care once the patient plateaus. A chiropractic practice has to track all three on every visit.
Key Takeaways
- Chiropractic manipulation bills as 98940, 98941, or 98942 by the number of spinal regions treated, and 98943 covers extraspinal regions.
- Medicare pays chiropractors only for spinal manipulation to correct a subluxation, billed with the AT modifier for active treatment.
- Maintenance care isn’t covered by Medicare, so those visits need a signed ABN and the GA modifier.
- Manual therapy (97140) on the same day as manipulation needs a separate body region and modifier 59 or XS.
- Many commercial plans manage chiropractic through networks like American Specialty Health or Optum Physical Health, which credential separately.
Chiropractic Manipulation Codes
Chiropractic manipulative treatment is coded by the number of regions treated, not by technique or time. CPT recognizes five spinal regions, which are cervical, thoracic, lumbar, sacral, and pelvic. Treating one or two of them bills as 98940, three or four as 98941, and all five as 98942. Extraspinal manipulation of the head, the upper or lower extremities, the rib cage, or the abdomen bills as 98943.
The note has to name each region treated and the findings that justified treating it. A claim for 98941 with documentation for only two regions is downcoded or denied on review, and a pattern of high-level codes without region-by-region findings draws audits.
Exams, modalities, and modifiers
A new-patient exam or a reevaluation for a new problem can be billed as an E/M visit on the same day as manipulation when it’s significant and separately identifiable, with modifier 25 on the E/M. A routine pre-manipulation assessment is part of the CMT code and isn’t billed separately.
Therapy codes such as therapeutic exercise (97110), neuromuscular reeducation (97112), mechanical traction (97012), and unattended electrical stimulation (97014) are covered by many commercial plans when a chiropractor provides them. Manual therapy (97140) on the same day as manipulation is the code that causes the most denials. NCCI bundles it into CMT unless it was done on a separate body region, and then it needs modifier 59 or XS with documentation showing the separate region.
Medicare Rules for Chiropractors
Medicare covers only one chiropractic service, manual manipulation of the spine to correct a subluxation. Exams, X-rays, extraspinal manipulation, and therapy modalities provided by a chiropractor aren’t covered, even when the same service would be paid if a physician or physical therapist provided it.
Active treatment bills with the AT modifier, which tells Medicare the patient is still expected to improve. The record has to support a subluxation using the PART criteria, which are pain, asymmetry or misalignment, range of motion abnormality, and tissue or tone changes. At least two of the four are required, and one of them has to be asymmetry or range of motion. The Medicare Benefit Policy Manual sets out these requirements, along with the treatment plan and progress documentation Medicare expects.
Once a patient stops improving and care continues to keep them stable, Medicare treats it as maintenance and won’t pay. Those visits need an Advance Beneficiary Notice signed before treatment and the GA modifier on the claim, so the patient can be billed if Medicare denies. Chiropractors can’t opt out of Medicare, so a chiropractor who treats Medicare patients for a subluxation has to bill Medicare for it.
Commercial Plans, Workers’ Comp, and Auto Claims
Many commercial plans and Medicare Advantage plans run chiropractic benefits through a specialty network such as American Specialty Health or Optum Physical Health. These networks set their own visit limits, require treatment plan submissions or authorization after a set number of visits, and pay from their own fee schedules. Being in network with the health plan doesn’t mean a chiropractor is in network with its chiropractic manager.
Workers’ compensation and personal injury or auto claims make up a large share of revenue at many chiropractic practices. They follow state fee schedules and claim rules instead of health plan policies, need the claim number and adjuster on file, and often require narrative reports before more visits are approved. Medicaid coverage for chiropractic varies widely by state, from full coverage to none.
Where Chiropractic Claims Get Denied
Most chiropractic denials come from a short list of causes. They include a CMT level that doesn’t match the regions documented, Medicare claims missing the AT modifier or the PART findings, maintenance visits billed to Medicare without an ABN, 97140 billed on the same region as the adjustment, visits past a network’s authorized count, and non-covered services billed to Medicare under a chiropractor’s NPI. A pre-billing check against each payer’s rules catches most of these before the claim goes out.
Chiropractic Credentialing
Licensure and Medicare enrollment
Payers verify each doctor of chiropractic’s state license, which requires passing the National Board of Chiropractic Examiners exams, along with malpractice coverage and any board certifications. Chiropractors enroll with Medicare individually and reassign benefits to their group, and the group enrolls as well. Medicaid enrollment, where the state covers chiropractic, runs separately.
Specialty networks
Each commercial plan credentials chiropractors on its own, usually through CAQH, and plans that use a chiropractic network manager require a separate application with that network. Some networks close panels in areas they consider full. Until a network approves the chiropractor, visits for its members can’t be billed, which is why you can’t bill what you can’t credential.
Multidisciplinary practices
Chiropractic groups that add physical therapists, acupuncturists, or nurse practitioners need each one enrolled under their own license type, since their services can’t be billed under the chiropractor’s NPI. Our physical therapy and holistic therapy pages cover those providers in more detail.
Payer Contracting for Chiropractic Practices
Chiropractic fee schedules from specialty networks are often well below what the same plans pay physical therapists for similar work, and visit caps limit what a patient’s care plan can earn. Payer contracting reviews should compare CMT and modality rates against Medicare and local benchmarks, check each contract’s visit limits and authorization rules, and decide which networks are worth the administrative cost of joining.
Chiropractic Billing FAQ
How is chiropractic manipulation coded?
By the number of regions treated. 98940 covers one or two spinal regions, 98941 covers three or four, 98942 covers all five, and 98943 covers extraspinal regions.
What does Medicare cover for chiropractors?
Only manual manipulation of the spine to correct a subluxation. Exams, X-rays, extraspinal manipulation, and therapy modalities provided by a chiropractor aren’t covered by Medicare.
When is the AT modifier used?
On Medicare CMT claims for active treatment, when the patient is still expected to improve. Without it, Medicare treats the visit as maintenance care and denies it.
Can maintenance chiropractic care be billed to Medicare patients?
Medicare won’t pay for it, but the patient can be billed if they signed an Advance Beneficiary Notice before treatment and the claim carries the GA modifier.
Can manual therapy be billed with chiropractic manipulation?
Only when it was performed on a separate body region from the manipulation. The claim needs modifier 59 or XS, and the note has to document the separate region.
Do chiropractors need to join ASH or Optum separately from the health plan?
Often, yes. Many health plans route chiropractic benefits through a specialty network like American Specialty Health or Optum, so a chiropractor who is in network with the plan still can’t bill those members until the network approves them. Medwave runs both applications together, and enrollment averages 85 days.
What Chiropractors Get with Medwave
Medicare chiropractic claims come down to the AT modifier and the documentation behind it. Medwave matches CMT levels to the regions documented, keeps 97140 off the same regions as the adjustment, and applies GA when maintenance care needs an ABN. Commercial visit limits and authorizations are checked before claims go out. Medwave’s clean claim rate for chiropractic billing is 98%.
Many plans manage chiropractic benefits through a specialty network instead of contracting directly, and our credentialing team enrolls chiropractors with both. Enrollment typically runs 85 days.
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