Chiropractic billing and coding can feel overwhelming, but it’s a critical part of running a successful practice. From documenting visits properly to selecting the right CPT codes, every detail matters when it comes to getting paid on time and keeping your revenue cycle healthy.
According to the American Chiropractic Association, practices lose an average of 10–15% of revenue every year due to coding errors and billing issues. That’s a significant loss that can be avoided with the right knowledge and support. In this article, we’ll walk you through the key aspects of chiropractic billing and coding and introduce how Medical Billers and Coders (MBC) can help simplify the process with expert solutions tailored just for chiropractors.
What Are Chiropractic Billing Services and Why Are They Important?
Chiropractic billing and coding isn’t just about submitting claims, it’s about making sure every service provided is accurately recorded and reimbursed. Chiropractors often deal with specific procedures like spinal manipulations, therapeutic exercises, and manual therapies, which require precise coding using CPT (Current Procedural Terminology), ICD-10, and HCPCS codes.
Common CPT Codes for Chiropractic Services
| CPT Code | Description |
| 98940 | Chiropractic manipulation (1–2 spinal regions) |
| 98941 | Chiropractic manipulation (3–4 spinal regions) |
| 98942 | Chiropractic manipulation (5 spinal regions) |
| 97035 | Application of ultrasound therapy |
| 97140 | Manual therapy (e.g., mobilization, myofascial release) |
Common ICD-10 Codes for Chiropractic Diagnosis
| ICD-10 Code | Description |
| M54.5 | Low back pain |
| M99.01–M99.09 | Segmental and somatic dysfunction (spinal regions) |
| M79.1 | Myalgia (muscle pain) |
| M54.2 | Cervicogenic neck pain) |
| M25.5X | Joint pain (requires 6th character for specific joint) |
Step-by-Step Chiropractic Claim Submission Process
The chiropractic claim submission process involves multiple checkpoints that ensure both compliance and reimbursement. It begins with patient registration, where accurate demographic details and insurance information are collected. At this stage, staff should confirm if the chiropractor is in-network and notify the patient about possible higher out-of-pocket costs when out-of-network.
There are several steps in the claim submission process of chiropractic medicine.
Patient Registration
Collect complete patient information, including demographics and insurance details. Ensure the chiropractor is in-network or inform the patient if out-of-network.
-
Confirm whether the chiropractor is in-network.
-
If out-of-network, inform the patient about higher out-of-pocket costs.
-
Store accurate secondary insurance details for coordination of benefits (COB).
Insurance Verification
Verify coverage for chiropractic services, including visit limits, copays, and pre-authorization requirements. Record verification details for future reference.
-
Verify coverage for chiropractic adjustments, therapy services and the number of visits allowed.
-
Identify co-pays, deductibles, and pre-authorization needs.
-
Document the verification call or portal check for future audits.
Document the Encounter
Use SOAP notes to document the visit’s reason, assessment, treatment plan, and patient progress. Proper documentation supports medical necessity.
-
Use SOAP notes (Subjective, Objective, Assessment, Plan).
-
Include patient complaints, exam findings, treatment performed, and outcomes.
-
Note progress over time to justify ongoing care.
Assign Proper Codes
Select the correct ICD-10 and CPT codes based on the services provided. For Medicare, add the AT modifier. Accurate coding is crucial to avoid denials.
-
Select precise ICD-10 diagnosis codes (e.g., M54.2 – Cervicalgia instead of just “neck pain”).
-
Use CPT codes for spinal manipulation (98940–98942) or extras like manual therapy.
-
For Medicare claims, always append the AT modifier to show active treatment.
Generate and Review the Claim
Generate the claim using billing software. Double-check patient details, codes, and dates. If using paper claims, complete the CMS-1500 form.
-
Double-check codes, provider NPI, patient info, and service dates.
-
Ensure documentation matches the codes billed.
-
For paper submissions, fill out the CMS-1500 claim form correctly.
Submit the Claim
Submit claims electronically via a clearinghouse or payer portal. Paper claims are an option if required by the payer.
-
Electronic submissions reduce errors and speed up reimbursement.
-
Use paper claims only if the payer specifically requires it.
Track Claim Status
Monitor the claim’s status through the clearinghouse or payer portal. Follow up within 15 days if there is no response.
-
Use clearinghouse reports or payer portals.
-
If no response within 15–20 days, contact the payer for updates.
Manage Denials and Rejections
If a claim is denied, identify the issue, correct it, and resubmit or appeal. Stay on top of visit limits and authorization requirements.
-
Identify the denial reason code (e.g., CO 16 – missing info, CO 18 – duplicate).
-
Correct errors and resubmit quickly.
-
Appeal with supporting documentation when necessary.
Post Payments
Post payments to the patient’s account, match payments with service lines, and send statements for any remaining balances.
-
Match each payment to service lines (CPT codes).
-
Send balance statements for deductibles, co-pays, or non-covered services.
Review and Audit Regularly
Conduct periodic audits to identify errors and improve processes. Review billed vs. paid amounts and stay updated on payer policies.
-
Compare billed vs. paid amounts to catch underpayments.
-
Track denial trends and correct workflow gaps.
-
Stay updated with CMS, Medicare, and commercial payer rule changes.
Challenges In Chiropractic Medical Billing
Chiropractic medical billing comes with unique hurdles that can delay reimbursement or trigger denials if not handled properly. Here are some of the most common challenges:
Limited Coverage by Insurance
Many insurance plans, including Medicare, cover only spinal manipulation and restrict visits, limiting reimbursement for additional therapies.
Medical Necessity Requirements
Payers often demand detailed documentation proving that chiropractic care is medically necessary, especially for ongoing treatment.
Frequent Claim Denials
Denials are common due to missing modifiers, incorrect coding, or exceeding visit limits, even with proper treatment provided.
Modifier Misuse
Not using required modifiers like AT (Active Treatment) for Medicare claims can lead to non-payment.
ICD-10/CPT Coding Errors
Using vague or non-specific diagnosis codes (e.g., “pain” without a detailed location) or mismatched CPT codes affects claim accuracy.
Limited Pre-authorization Options
Some plans require pre-authorization for chiropractic services, but the process is often unclear or inconsistently enforced.
Complex Payer Rules
Each insurance company may have different rules for what’s covered, how to document it, and when to submit.
Tips For Improving Chiropractic Medical Billing
Medical billing for chiropractors is crucial, there are some tips that you can follow to improve the billing process.
Utilize Chiropractic-Specific Billing Software
Investing in billing software tailored for chiropractic care ensures better accuracy and workflow automation. These platforms are designed to handle chiropractic CPT codes, documentation requirements, and payer-specific guidelines.
Benefits include:
- Automated coding and claim submissions
- Integration with SOAP notes and EHR systems
- Reduced administrative errors
Conduct Insurance Verification Before Each Visit
Verifying patient insurance coverage before services helps avoid surprises and denials.
- Confirms eligibility and chiropractic benefits
- Identifies visit caps and pre-authorization needs
- Prevents claim denials and improves transparency
Understand and Accurately Apply Chiropractic CPT Codes
- Use codes 98940–98942 appropriately
- Apply modifiers: AT (Active Treatment), GA (Waiver of Liability), GZ (No ABN)
- Ensure coding aligns with documentation
Stay Informed on Payer-Specific Policies
Payer rules regarding chiropractic care can vary widely. Staying up to date is essential to avoid denials due to non-compliance.
- Maintain a payer-specific cheat sheet
- Review insurer updates regularly
- Train the billing staff on changing rules
Ensure Detailed and Consistent Documentation
Proper documentation is crucial in proving medical necessity and supporting claims. Chiropractors should consistently document using standardized methods.
- Use structured SOAP notes
- Include diagnosis, treatment plan, and measurable outcomes
- Support all claims with proper clinical justification
Proactively Manage Denials and Rejections
Stay on top of claim denials by analyzing denial codes and reasons regularly. Submit timely appeals with complete documentation, and track recurring issues to fix the root causes. This approach helps reduce rework and protects your revenue.
Provide Ongoing Staff Education
Keep your billing team sharp with regular training on coding, compliance, and payer updates. Encourage participation in webinars and certifications, and conduct routine audits to catch errors early and maintain billing accuracy.
Consider Outsourcing Billing Services
Outsourcing can ease your administrative burden and improve claim approval rates. A billing partner brings expertise, stays updated on payer rules, and helps ensure faster, more accurate reimbursements while you focus on patient care.
Benefits of outsourcing medical billing for chiropractic medicine:
Outsourcing medical billing has become an increasingly strategic move for chiropractic practices aiming to improve efficiency, reduce overhead, and ensure billing accuracy. Below are some of the key advantages of outsourcing billing services in chiropractic medicine:
- Improved Revenue Cycle Management
Faster claim processing and fewer denials lead to better cash flow. - Reduced Administrative Burden
Frees up in-house staff to focus on patient care and front-office operations. - Access to Billing Expertise
Professional billing companies stay updated on payer rules, coding changes, and compliance standards specific to chiropractic care. - Fewer Errors and Denials
Experienced billers reduce coding errors, missed modifiers, and incomplete claims. - Cost Savings
Eliminates the need for hiring, training, and maintaining a full billing department. - Real-Time Reporting and Analytics: Most billing services provide dashboards and reports to track financial performance and billing trends.
- Scalability: Easily handle increases in patient volume without worrying about billing capacity.
- Better Compliance and Risk Management: Ensures adherence to HIPAA, payer guidelines, and chiropractic-specific billing requirements.
Final Thoughts
Chiropractic medical billing and coding can be complex, but with the right strategies, tools, and expertise, it doesn’t have to be a burden. By understanding key codes, following payer-specific rules, maintaining detailed documentation, and improving your claim submission process, your practice can minimize denials and maximize revenue.
Whether you choose to manage billing in-house or outsource to a trusted partner, staying informed and proactive is essential. Investing in accurate billing today means a healthier financial future for your chiropractic practice and more time to focus on what truly matters: your patients.
Why choose Health Quest?
Managing chiropractic billing in-house can be overwhelming and time-consuming, especially when you’re trying to balance patient care and administrative tasks. That’s where we come in. At Health Quest, we specialize in chiropractic medical billing and coding, offering tailored solutions that boost accuracy, reduce denials, and improve your revenue cycle. From insurance verification to claims submission and denial management, our team handles it all so you can focus on healing, not paperwork.
Schedule an appointment today, call us at (415) 508-6537 to improve your revenue cycle and overall billing process.
