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Chiropractic Billing Services

Chiropractic billing centers on one family of manipulation codes, but whether those codes are paid depends on documentation of subluxation, whether care is active or maintenance, and which payer is responsible: Medicare, a commercial plan with a visit cap, an auto insurer or the patient. Each needs a different process.

  • Spinal regions counted and matched to the right CMT code
  • AT modifier applied only to active, corrective care
  • Auto and personal injury cases billed to the responsible payer
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Active care, maintenance care and who pays

Medicare covers only one chiropractic service: hands-on spinal manipulation that corrects a subluxation. Exams, X-rays, therapies and extraspinal manipulation performed by a chiropractor are not covered, and the covered manipulation must be active or corrective treatment, marked with the AT modifier. Once a patient reaches maximum improvement, further visits are maintenance care and are not medically necessary for Medicare purposes.

Documentation decides coverage. Medicare requires the subluxation to be shown either by X-ray or by physical examination, and the exam findings cover four areas, often called PART: pain, asymmetry or misalignment, range of motion changes and tissue or tone changes, with at least two present and one of them being asymmetry or range of motion.

Commercial plans are more generous about services but strict about volume, with annual visit limits and often a specialty benefit manager that authorizes care in blocks. A large part of many practices' work also comes from auto accidents, where personal injury protection, med-pay or an attorney lien may be the payer instead.

CMT codes, Medicare modifiers and diagnosis rules

The coding choices that decide most chiropractic payments.

Chiropractic manipulation codes, Medicare modifiers and diagnosis rules with billing notes
Codes or modifiersWhat they meanBilling notes
98940, 98941, 98942Spinal manipulation of 1 to 2, 3 to 4, and 5 spinal regions.The regions treated, and the findings for each, must be documented.
98943Extraspinal manipulation, such as the extremities.Not covered by Medicare when performed by a chiropractor; commercial coverage varies.
ATActive or corrective treatment.Required on Medicare manipulation claims for active care; maintenance visits are billed without it.
GA, GZ, GYAdvance beneficiary notice on file, not on file, and statutorily excluded service.GA with a signed ABN lets the practice bill the patient if maintenance care is denied; GY marks services Medicare never covers from chiropractors.
M99.0x and a secondary diagnosisSegmental dysfunction (subluxation) codes by region.Medicare requires the subluxation, with its level, as the primary diagnosis. Some Medicare contractors also require the related condition as a secondary diagnosis, so we follow the billing article for your contractor.
E/M with modifier 25A separate evaluation on the same day as manipulation.Medicare does not pay chiropractors for E/M visits. Under NCCI rules, CMT has a 000-day global period, so a same-day E/M is only separately reportable when significant and separately identifiable, with modifier 25; other payers set their own rules.

CPT is a registered trademark of the American Medical Association.

Official sources: CMS Benefit Policy Manual, chapter 15 (chiropractic services) (external site), CMS: Physician fee schedule relative value file (code descriptors) (external site), CMS Medicare Coverage Database: article A57889 (chiropractic services) (external site), CMS Medicare Coverage Database: article A56455 (ABN modifiers) (external site), CMS Medicare Coverage Database: article A56273 (chiropractic billing) (external site), CMS NCCI Policy Manual, chapter 11 (CMT global period) (external site), CMS Claims Processing Manual, chapter 30 (ABNs) (external site)

Chiropractic claims that come back unpaid

  • Maintenance care billed as active

    AT added after the patient has plateaued, without documented functional goals or measurable improvement.

  • Subluxation not supported by the note

    Exam findings that do not meet the PART criteria for the regions billed.

  • Regions billed do not match regions treated

    A 98941 for treatment documented in only two regions.

  • Non-covered services sent to Medicare as covered

    Exams, X-rays or therapies billed to Medicare without GY or an appropriate patient notice.

  • Visit limits reached

    Commercial plans that allow a fixed number of visits per year, or approve them in small blocks.

  • Accident claims billed to the health plan first

    The health plan denies because auto coverage should pay first.

How we bill for chiropractic offices

  1. Step 1: Check the documentation pattern

    Notes are reviewed for subluxation findings, regions treated and treatment goals before claims are released.

  2. Step 2: Mark the care phase

    Each Medicare episode is tracked as active or maintenance, so AT and ABN handling follow the patient's progress.

  3. Step 3: Count visits per plan

    Visits are tracked against annual limits and authorized blocks, with requests made before the last approved visit.

  4. Step 4: Route accident cases

    Auto, med-pay and personal injury cases are set up with the right payer, claim number and attorney details at intake.

Cash plans, personal injury and how chiropractic differs from physical therapy

Cash and membership plans are common in chiropractic, but Medicare rules limit them. Chiropractors cannot opt out of Medicare, so covered manipulation for a Medicare patient must be billed to Medicare, and cash plans have to fit each payer's rules and state law. Personal injury cases follow each state's auto insurance rules, which we check case by case.

Chiropractors and physical therapists both bill manual therapy and exercise codes for some payers, and many patients see both. The difference for billing is that chiropractic payment depends on manipulation codes and subluxation documentation, while physical therapy depends on timed units and a certified plan of care. Our physical therapy billing page covers those rules.

Frequently asked questions

What is the difference between active and maintenance care for Medicare?

Active care aims to improve or correct the condition and is documented with goals and measurable progress; it is billed with AT. Maintenance care keeps the patient stable after improvement stops and is not covered by Medicare.

How do we bill a Medicare patient who wants maintenance visits?

Give the patient an advance beneficiary notice before the maintenance visits, bill the manipulation without AT and with GA, and the patient can then be billed if Medicare denies it.

What documentation shows a subluxation?

For Medicare, an X-ray or a physical exam that meets the PART criteria for each region treated. Commercial payers often follow similar documentation expectations.

Can we bill an exam on the same day as an adjustment?

Not to Medicare, which covers only the manipulation itself when a chiropractor provides it. With other payers, a same-day exam is billable only when it is significant and separately identifiable, such as for a new problem, and documented separately with modifier 25; we check each payer's policy.

How are car accident patients billed?

The order of payers depends on the state and the patient's policies, and can involve auto coverage such as personal injury protection or med-pay, health insurance, or an attorney lien. We confirm the order at intake, before the first claim.

Related services and specialties

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Questions about Medicare maintenance care or PI cases?

Call us to talk through how your office handles active care, cash plans and accident claims, or start with a free audit.

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