Specialty billing
Chiropractic billing services
Chiropractic billing is coding each adjustment by the number of spinal regions treated, with the diagnoses and modifiers that show it was active treatment, and claiming it under each plan’s chiropractic rules.
Chiropractic
The regions decide the code
- 1–2 regions98940
- 3–4 regions98941
- 5 regions98942
- Outside the spine98943
Try it
Find the manipulation code
Adjustments are coded by the number of spinal regions treated, and the note has to name each one.
Which manipulation code?
2 of 5 regionsTick each spinal region the note says was treated.
- 98940AT if active treatment
98940 is one or two spinal regions, 98941 three or four, 98942 five. Medicare pays only for active, corrective treatment of a subluxation, marked with AT; maintenance care isn’t covered.
Why is chiropractic billing hard?
Adjustments are coded by region
Chiropractic manipulative treatment is billed as 98940 (one or two spinal regions), 98941 (three or four) or 98942 (five), with 98943 for regions outside the spine, and the note has to name each region treated.
Medicare pays for one service
Medicare covers only manual manipulation of the spine to correct a subluxation. Exams, X-rays, therapies and extraspinal adjustments aren’t covered when a chiropractor provides them, so the patient pays for those.
Active treatment or maintenance
Medicare pays for active, corrective treatment, marked with the AT modifier. Maintenance care isn’t covered, and the practice can bill the patient for it only with a signed Advance Beneficiary Notice on file (modifier GA).
The record has to show the subluxation
The subluxation is shown by X-ray or by exam: two of pain, asymmetry, range-of-motion change and tissue change, one of them asymmetry or range of motion. The claim also gives the date the course of treatment began.
Other services on the same day
An exam or a therapy billed with an adjustment needs modifier 25 or 59 and a note that shows it was separate, or the payer bundles it into the manipulation.
What Beeline handles for chiropractic practices
- Medical codingEach visit coded from the note: the manipulation level by regions treated, the subluxation diagnosis for each region, and the AT, GA or GZ modifier Medicare needs.
- Eligibility verificationChiropractic benefits checked before treatment: visits allowed, what is covered, and what the patient owes.
- Claims submissionClaims checked for the details each payer asks for, such as the date treatment began, before they are sent.
- Denial managementMaintenance, bundling and documentation denials traced to their cause, then corrected or appealed.
- Payment postingPayments and patient balances posted visit by visit, so what the plan paid and what the patient owes are both clear.
Chiropractic billing questions
What is the AT modifier in chiropractic billing?
What does Medicare cover for chiropractic care?
When are the GA and GZ modifiers used?
Find out where your chiropractic billing stands.
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