Specialty billing
Chiropractic Medical Billing Services
Chiropractic billing is constrained by unusually narrow coverage: Medicare covers only spinal manipulation, and only when active treatment is documented rather than maintenance care. The active-versus-maintenance distinction determines payment on essentially every claim, and it is established entirely by documentation.
Chiropractic benchmarks
- Typical denial rate
- 13–20%
- Days in AR
- 34–46
- Achievable clean claim rate
- 96%+
Typical ranges for chiropractic practices. Your actual numbers are measured during the audit.
The complexity
Why chiropractic is uniquely difficult to bill
Medicare covers spinal manipulation only — exams, x-rays and modalities are excluded
The AT modifier is required to indicate active treatment rather than maintenance
Maintenance care is not covered and requires advance beneficiary notice
Manipulation codes are selected by the number of spinal regions treated
Documentation must show measurable functional improvement to sustain active treatment
Commercial plans commonly impose visit caps per benefit year
Coding
Chiropractic procedure codes we work with daily
A representative sample, not an exhaustive list. Coders are assigned by specialty rather than pooled.
| Code | Description |
|---|---|
| 98940 | Chiropractic manipulative treatment, one to two spinal regions |
| 98941 | Chiropractic manipulative treatment, three to four spinal regions |
| 98942 | Chiropractic manipulative treatment, five spinal regions |
| 97140 | Manual therapy techniques, each 15 minutes |
| 97012 | Mechanical traction, supervised modality |
| 97110 | Therapeutic exercise, each 15 minutes |
Revenue leakage
Where chiropractic practices lose money
These are the denial patterns specific to this specialty — the ones a general-purpose billing service will not be looking for.
Missing AT modifier
Manipulation claims denied because the AT modifier establishing active treatment was not appended.
Maintenance care determination
Continued treatment denied where documentation no longer demonstrates measurable functional improvement.
Non-covered services to Medicare
Examinations, x-rays and physical modalities billed to Medicare, which covers manipulation only.
Region count errors
Manipulation code billed for more spinal regions than the documentation supports.
Visit caps exceeded
Commercial claims denied after the plan's annual visit allowance was exhausted without tracking.
Payer landscape
What chiropractic practices need to know about payers
Payer policy drives more chiropractic denials than coding does. Knowing the policy before the service is what prevents them.
- Medicare covers spinal manipulation only; everything else performed in a chiropractic visit is patient responsibility and requires advance notice.
- The AT modifier is not optional — its absence signals maintenance care and produces an automatic denial.
- Commercial plans typically cap chiropractic visits per benefit year, so remaining visits must be tracked per patient.
Questions
Chiropractic billing FAQ
Last updated August 20, 2026
Reviewed by a certified coding leadAT signals active treatment — care expected to produce measurable functional improvement — as distinct from maintenance care, which Medicare does not cover. Manipulation claims submitted without AT are treated as maintenance and denied automatically. It is the single most consequential modifier in chiropractic billing.
By whether documentation continues to show measurable functional improvement. Notes that repeat the same findings visit after visit without objective progress suggest the patient has plateaued, which is the definition of maintenance. Documenting specific, changing functional measures is what sustains active treatment status.
Spinal manipulation only. Examinations, x-rays, physical therapy modalities and supplies are all excluded, even when clinically appropriate. Those services can be provided and billed to the patient, but an advance beneficiary notice must be issued first so the patient's financial responsibility is established.
By the number of spinal regions treated: 98940 for one to two, 98941 for three to four, 98942 for five. The documentation must identify each region treated and the clinical rationale. Billing 98941 by default when the note supports only two regions is a common audit finding.
Primary sources
Coverage, rates and local policy for chiropractic, at the source.
- Medicare Benefit Policy Manual (opens in a new tab)
Centers for Medicare & Medicaid Services — What Medicare covers and under what conditions, as distinct from how a claim is processed. The starting point for any coverage or medical necessity question.
- Advance Beneficiary Notice of Noncoverage (ABN) (opens in a new tab)
Centers for Medicare & Medicaid Services — The form and the rules for issuing it. Whether a non-covered service can be billed to the patient usually turns on whether a valid ABN was obtained beforehand.
- Medicare Coverage Database (LCD/NCD) (opens in a new tab)
Centers for Medicare & Medicaid Services — Searchable national and local coverage determinations. The direct answer to whether a diagnosis supports medical necessity for a given procedure.
Reading
Chiropractic billing, in depth
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