Specialty
Chiropractic billing services
Chiropractic billing services live on a narrow set of codes with unusually strict rules: Medicare pays only for manual manipulation of the spine to correct a subluxation, in active treatment, with the diagnosis and modifier to prove it, while commercial plans add visit caps and bundle the exam into the adjustment.
See where claims are getting stuck. No patient data needed.
Remitwright gives chiropractic practices a dedicated biller who knows which payer pays for what, gets the ABN signed before maintenance care, and keeps the visit count ahead of the limit.
Chiropractic billing is one of Remitwright's specialty billing services, each set out with its own code families, denial reasons and payer rules.
Last reviewed by the Remitwright billing team. Editorial policy
- 72020-72110
- 97110
- 98940-98942
Denials
Why chiropractic claims get denied
The reasons that come up most on chiropractic remittances, with the usual cause and the fix. Code explanations are our own; the official list is maintained by X12.
| Code | Reason | Usual cause | The fix |
|---|---|---|---|
| CO-50 | Not medically necessary, treated as maintenance | AT modifier missing, or the documentation shows no expected functional improvement | AT only when the note supports active treatment; treatment plan with measurable goals; ABN and GA for maintenance care |
| CO-16 | Missing or invalid diagnosis | The subluxation diagnosis is not primary, is missing the spinal level, or has no secondary diagnosis for the condition causing the problem | Subluxation code with level first, condition second, matched to the regions billed, checked by a scrubber rule |
| CO-96 | Non-covered service | Extraspinal manipulation, X-rays or therapy billed to Medicare under the chiropractic benefit | Know what each payer covers before the visit; bill excluded services to Medicare with GY only when a secondary needs the denial |
| CO-119 | Benefit maximum reached | A commercial visit cap exhausted without anyone counting | Record the cap at eligibility, count visits against it, and talk to the patient before the capped visit |
| CO-97 | Bundled, not separately payable | An exam billed with the adjustment without modifier 25, or without documentation of a separate service | Modifier 25 only for the first visit or a new problem, with the exam documented apart from the adjustment |
Codes
Common chiropractic codes and modifiers
Code families by number with our own one-line explanations. CPT descriptors belong to the AMA and are not reproduced here.
| Codes | What the family covers |
|---|---|
| 72020-72110 | Spinal X-rays, which Medicare does not cover when ordered or performed by a chiropractor, and which commercial plans cover under their own rules |
| 97110, 97140, 97012, 97014 | Therapy and modality codes that some commercial plans pay a chiropractor for and Medicare does not under the chiropractic benefit |
| 98940-98942 | Chiropractic manipulative treatment of the spine, coded by the number of spinal regions treated; the only chiropractic services Medicare covers |
| 98943 | Manipulation of extraspinal regions such as the shoulder or hip, paid by some commercial plans and not covered by Medicare |
| 99202-99215 | Evaluation and management on the first visit or for a new problem, billed with modifier 25; many payers bundle a routine exam into the adjustment |
Modifiers that matter
- AT
- Required on 98940 to 98942 for Medicare to show active treatment of a subluxation. Without it Medicare treats the visit as maintenance and denies it.
- GA
- Shows that an advance beneficiary notice is on file for care Medicare is expected to deny, such as maintenance adjustments, so the patient can be billed.
- 25
- A separately identifiable evaluation and management service on the same day as the adjustment. The note must show an exam and decision making beyond the adjustment itself.
- GY
- A service statutorily excluded from Medicare, such as X-rays or therapy by a chiropractor, billed to obtain the denial a secondary payer needs.
Payers
Payer notes
- MedicareCoverage is limited to manual manipulation of the spine to correct a subluxation. X-rays, examinations, laboratory tests and therapy ordered or performed by a chiropractor are not covered, and maintenance therapy is excluded once the patient has reached maximum improvement.1
- MedicareClaims for 98940 to 98942 must carry the AT modifier to indicate active treatment, a primary subluxation diagnosis with the level, and the date of initial treatment for the episode; contractors publish the documentation elements they expect in their coverage articles.2
- Commercial plansMany apply NCCI-style bundling between an evaluation and the adjustment on the same day, paying both only when modifier 25 is supported by a separately documented service.3
Authorizations
Medicare does not require prior authorization for chiropractic manipulation but limits coverage to active treatment of a documented subluxation, which does the same job after the fact. Commercial plans often cap visits per year and some require authorization after an initial allowance; a few route chiropractic care through a musculoskeletal management vendor with its own portal and its own treatment plan forms. Your biller records the limit at eligibility, tracks visits against it, and gets the plan on file before the allowance runs out.
Documentation traps
- The subluxation elements the contractor expects, such as pain, asymmetry, range of motion and tissue changes, not recorded at the initial visit and at intervals after
- A treatment plan without measurable goals and an expected duration, which makes every visit look like maintenance
- The date of initial treatment missing from the claim for Medicare episodes
- Maintenance care documented in the same words as active care, with no ABN signed, so the patient cannot be billed when Medicare denies it
What a specialist checks
Specialist or generalist for chiropractic billing?
A generalist biller can enter a chiropractic claim. Whether it pays turns on three things specific to chiropractic billing, and a specialty-aware biller checks each one.
Code families
Each family billed with what the chart has to show for it.
- 72020-72110
- 97110, 97140, 97012, 97014
- 98940-98942
Modifiers
Applied only where the note supports them, line by line.
- AT
- GA
- 25
If you are moving from another billing company or an in-house biller, switching billing companies follows a plan: the old and new processes run side by side until the new one is proven, and every login and every chiropractic claim stays in your name.
What we handle
What we handle for chiropractic practices
- Medical codingCPT, ICD-10 and modifiers assigned correctly
- Claim submissionScrubbed, submitted and tracked to acceptance
- Denial managementEvery denial read, worked and appealed
- Eligibility verificationCoverage and benefits checked before visits
- Patient billing supportStatements, questions and payment plans handled
A dedicated biller with named cover, working inside your system and reporting to you on one written page. How it works sets out the five stages.
Software
Systems chiropractic practices usually run
Your biller works inside your system as a user you create. All the systems we work in.
Questions
Questions about chiropractic billing
Does Medicare pay for chiropractic X-rays?
What is the AT modifier?
Can we bill an exam with the adjustment?
How do commercial visit limits work?
What is an ABN and when do we need one?
What do you need from a chiropractic practice to start?
Next step
See where your chiropractic claims are getting stuck.
Three quick questions. No patient data. A billing specialist reads every request and replies in writing.
- Three questions, about two minutes
- No patient data, no software to buy
- A written reply from a biller, not a sales deck
You answer three questions
A billing specialist reads them
A written reply by email
Prefer email? sales@remitwright.com
Request received
Thanks. Your review request is in.
Reference . Quote it if you write to us about this request.
- A billing specialist reads your answers and replies by email.
- If a look at real claims makes sense, we agree read-only access under a BAA first.
- You get a written summary of what is worth working and what it would take. No commitment.
While you wait: see the sample weekly report or read how switching works. You can also download the sample weekly report (PDF).