Chiropractic care is gaining mainstream traction in the U.S., with patients seeking natural, non-invasive solutions for chronic pain, mobility issues, and overall wellness. But while demand is growing, many chiropractic practices face a different challenge: getting paid on time and in full.
Whether it’s coding complexity, documentation gaps, or payer pushback on medical necessity, billing insurance claims as a chiropractor is anything but straightforward. At Global Tech Billing LLC, we work with chiropractic clinics across the U.S. to help them simplify coding, avoid denials, and increase collections.
This comprehensive guide walks through the latest chiropractic billing and coding best practices—designed to give your practice financial clarity and peace of mind in 2025.
Why Chiropractic Billing Is Uniquely Complex
Chiropractic care often includes spinal manipulation, physical therapy modalities, exams, and maintenance care. Insurance companies don’t always reimburse these services equally—and many limit coverage unless strict documentation and coding rules are followed.
Key challenges chiropractors face:
- Frequent denials due to “lack of medical necessity”
- Incorrect modifier use
- Difficulty billing multiple services per visit
- Confusion around maintenance vs. active care
- Inconsistent policies across payers (especially Medicare, BCBS, and Cigna)
Top CPT Codes Used in Chiropractic Billing
Knowing and applying the correct codes is crucial. Below are essential codes for chiropractic insurance claims:
Chiropractic Manipulative Treatment (CMT) Codes
- 98940 – 1–2 regions
- 98941 – 3–4 regions
- 98942 – 5 regions
These are region-based codes, so accurate documentation is key. For example, billing 98941 requires documentation for at least three spinal regions (e.g., cervical, thoracic, lumbar).
Common Adjunct Therapies (if allowed by scope)
- 97010 – Hot/cold packs
- 97012 – Mechanical traction
- 97110 – Therapeutic exercise
- 97140 – Manual therapy (massage, trigger point)
Important: Most commercial payers require Modifier 59 or GP to unbundle these services from the CMT.
E/M Codes for Exams
- 99202–99215 – New and established patient office visits
- Use these codes only when a significant, separately identifiable evaluation is performed. Add Modifier 25 when billing on the same day as CMT.
How to Document Medical Necessity for Chiropractic Claims
Insurers often deny chiropractic claims for failing to meet medical necessity. Here’s how to defend your care:
Required documentation elements:
- Initial exam and diagnosis (e.g., subluxation with functional loss)
- Treatment plan (frequency, duration, expected outcomes)
- Objective findings (ROM, palpation, orthopedic tests)
- Progress notes (per visit, showing functional improvement)
- Discharge plan or shift to maintenance care.
Tip: Avoid “cloning” notes or repeating identical phrasing in every visit—payers see this as a red flag.
Chiropractic Billing for Medicare: Know the Limits
Medicare only covers spinal manipulation (CMT) and only when the treatment is considered active care, not maintenance.
Key rules:
- No coverage for exams, x-rays, or adjunct therapies
- Documentation must include subluxation diagnosis (ICD-10 M99 codes)
- Must use AT modifier to indicate active treatment
- Use the GA modifier if the patient refuses an ABN form
At Global Tech Billing LLC, we help chiropractors avoid costly Medicare denials by implementing compliant documentation templates and ABN workflows.
Understanding Maintenance vs. Active Care
Many chiropractors face denials for providing what insurers consider “maintenance care.” Here’s how to tell the difference:
Active CareMaintenance Care
Focused on functional improvement Aimed at preventing regression
Objective, measurable goals No new condition or symptom change
Covered by insurance Often not covered
Pro tip: Always clearly state clinical justification in your treatment notes when transitioning between phases.
Common Billing Errors Chiropractors Should Avoid
- Overuse of Modifier 25
- Used too freely, this modifier can trigger payer audits. Only apply it when documentation supports a separate E/M service.
- Underdocumenting CMT levels
- Don’t bill 98941 or 98942 without clearly charting 3–5 spinal regions.
- Not appealing denials
- Appealable claims often get left behind. At Global Tech Billing LLC, we recover an average of 18% more revenue from denied claims through timely appeals.
Coding Tips That Increase Chiropractic Reimbursement
Use Modifiers Correctly
- Modifier 25 – E/M visit with same-day CMT
- Modifier 59 – Distinct procedure (manual therapy vs. manipulation)
- Modifier AT – Active treatment (Medicare)
- Modifier GP – Therapy plan of care required by some payers
Leverage Diagnosis Pairing
Pair ICD-10 musculoskeletal codes with CMT codes accurately. For example:
- M54.5 (Low back pain) → CMT for lumbar region
- M99.01 (Subluxation, cervical) → CMT for cervical
Real-World Insight: A Maryland Practice Boosts Collections
A 2-provider chiropractic clinic in Maryland was losing over $5,000/month in denials—primarily due to incomplete documentation and misuse of modifiers. After partnering with Global Tech Billing LLC, they:
- Recovered $23,000 in denied claims within 90 days
- Improved first-pass clean claim rate to 98.7%
- Integrated a weekly billing review system to catch errors early
Their team now spends less time on billing, and more on patient care.
Chiropractic Billing Software vs. Expert Support
Billing software can speed up claim generation, but it won’t:
- Review documentation for payer compliance
- Appeal denied claims
- Customize billing rules per payer
- Educate your team on coding updates
That’s why many chiropractors rely on specialized billing partners like Global Tech Billing LLC to handle the revenue cycle with greater precision and accountability.
Conclusion: Chiropractic Billing Doesn’t Have to Be a Pain
In 2025, chiropractors can no longer afford to rely on outdated billing methods or generic EHR tools. With increasingly strict payer guidelines, successful practices need to code accurately, document thoroughly, and bill strategically.
At Global Tech Billing LLC, we help chiropractors do just that—offering expert coding support, denial management, Medicare compliance, and ongoing billing education tailored to your specialty. The result? More collections, fewer headaches, and a stronger bottom line.
FAQs
1. Can I bill an E/M visit and spinal manipulation on the same day?
Yes, if the E/M visit is medically necessary and distinct. Use Modifier 25 and document clearly.
2. Why do my Medicare chiropractic claims get denied?
Most likely due to missing AT modifiers, lack of subluxation diagnosis, or insufficient documentation of active care.
3. What’s the difference between 98940 and 98941?
98940 is for 1–2 regions; 98941 is for 3–4. You must chart and justify each region treated.
4. Do commercial payers cover manual therapy and exercises?
Some do, but they often require Modifier 59 or documentation of medical necessity alongside CMT.
5. How can Global Tech Billing LLC help my chiropractic clinic?
We specialize in chiropractic RCM—offering clean claims, payer-specific rules, documentation audits, and appeals that get results.
