Chiropractic Medical Billing Services

Chiropractic Billing That Gets Active vs. Maintenance Care Right.

Chiropractic claims face some of the highest documented improper-payment scrutiny of any Medicare Part B category. MedVersify's chiropractic billing team builds every claim around AT-modifier compliance, documented PART findings, and the narrow scope of what Medicare actually covers.

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What Federal Reviews Have Found

Chiropractic Billing Carries Real, Documented Risk

33.6%

Improper-Payment Rate on Chiropractic Claims

CMS's 2024 Comprehensive Error Rate Testing (CERT) supplemental data found a 33.6% improper-payment rate on chiropractic claims — around $178 million projected — with insufficient documentation responsible for the large majority of those errors.

CMS 2024 CERT Supplemental Improper Payment Data

$76M+

Questionable Medicare Payments Identified

A national HHS-OIG review of chiropractic claims found at least $76 million in questionable Medicare payments, including $21 million billed for claims lacking a Medicare-covered diagnosis.

HHS-OIG Report OEI-01-14-00200

40–47%

Of Paid Claims Were Non-Covered Maintenance Care

The same OIG review found 40–47% of all paid chiropractic claims nationwide were for maintenance therapy — a service Medicare does not cover under any circumstances.

HHS-OIG Report OEI-01-14-00200

2 of 4

PART Elements Required to Document Subluxation

CMS requires at least two of four PART elements — Pain/tenderness, Asymmetry, Range-of-motion abnormality, Tissue changes — with at least one being asymmetry or range-of-motion, to establish a billable subluxation.

CMS Medicare Benefit Policy Manual, Ch. 15 §240.1.3

Why Chiropractic Billing Is Different

A Narrow Coverage Rule With Very Little Margin for Error

Which is exactly why medical billing done right has to start with specialty-specific coding knowledge, not a generic claims process.

Medicare covers one thing, narrowly defined

Medicare pays only for manual manipulation of the spine to correct a subluxation (CPT 98940–98943). Exams, x-rays, and most modalities chiropractors routinely perform are not separately covered the way they are with other specialties — billing them as if they are is a fast path to denial.

PART documentation is the standard, not a suggestion

CMS requires at least two of four specific PART elements — Pain/tenderness, Asymmetry, Range-of-motion abnormality, Tissue tone/texture/temperature changes — with at least one being asymmetry or range-of-motion, before a subluxation is billable at all. Vague notes that don't map to these four elements are a documented audit trigger, not a technicality.

The AT modifier is not optional paperwork

The AT modifier attests that a service is active or corrective treatment, not maintenance. Given that CMS's own 2024 CERT data found insufficient documentation behind the large majority of chiropractic claim errors, correct AT-modifier use backed by real PART documentation is one of the highest-leverage things chiropractic billing can get right.

Maintenance care is statutorily excluded — full stop

Once a patient plateaus and further care is intended to maintain rather than improve their condition, Medicare coverage ends by law. Distinguishing "still improving" from "maintaining" requires documented functional progress, not a recurring treatment plan on autopilot.

Medicare Advantage plans do not follow traditional Medicare rules

Original Medicare requires no referral or prior authorization for covered chiropractic care and imposes no visit cap. Many Medicare Advantage plans require prior authorization and impose their own annual visit limits — treating an MA patient like a traditional Medicare patient is a common, avoidable source of denials.

Chiropractic claims draw outsized audit attention

Given the documented improper-payment history above, chiropractic claims are reviewed more closely, relative to volume, than many other specialties. A clean claim history and defensible documentation matter more here, not less.

Common Chiropractic Billing Codes

98940

CMT, Spinal, 1–2 Regions

Chiropractic manipulative treatment covering one or two spinal regions in a single encounter.

98941

CMT, Spinal, 3–4 Regions

Manipulative treatment covering three or four spinal regions — the most commonly billed CMT code.

98942

CMT, Spinal, 5 Regions

Manipulative treatment covering all five spinal regions in one encounter.

98943

CMT, Extraspinal

Manipulation of one or more extraspinal regions — head, extremities, rib cage, abdomen — billed separately from spinal CMT.

97140 / 97110

Manual Therapy & Therapeutic Exercise

Commonly billed alongside CMT when documentation supports a distinct, medically necessary service beyond the adjustment itself.

72040–72120

Spinal X-Ray Series

Imaging codes for cervical, thoracic, and lumbosacral spine series, used to support a documented subluxation finding.

Denial Prevention

The Denial Patterns Chiropractic Practices See Most

Insufficient PART Documentation

CMS's own 2024 CERT data attributes the large majority of chiropractic claim errors to insufficient documentation — notes that don't clearly establish two of the four required PART elements.

MedVersify Approach

We check every claim against the specific PART elements CMS requires before submission, not after a denial.

Missing or Misapplied AT Modifier

Active treatment billed without the AT modifier, or the modifier applied to what documentation actually shows is maintenance care — both trigger automatic denial or downstream audit risk.

MedVersify Approach

AT-modifier use is tied directly to documented functional progress, not applied by default.

Medicare Advantage Rule Mismatches

Claims billed as if an MA plan follows traditional Medicare's no-prior-auth, no-visit-cap rules, when the plan actually requires authorization or imposes an annual limit.

MedVersify Approach

We track each Medicare Advantage plan's specific chiropractic authorization and visit-limit rules separately from traditional Medicare.

Our Process

How MedVersify Handles Chiropractic Billing

PART & AT-Modifier Documentation Review

We check every claim for the specific PART elements CMS requires and confirm the documented subluxation and treatment goal actually support active care, not maintenance.

CMT Coding & Claim Scrubbing

CPT 98940–98943 and related codes are applied per current Medicare and commercial payer rules, then run through claim scrubbing before submission.

Medicare Advantage Rule Tracking

Each Medicare Advantage plan's prior-authorization and visit-limit rules are tracked separately from traditional Medicare, rather than assumed to match.

Submission & Tracking

Every claim is submitted electronically and tracked to acceptance, with same-day correction on clearinghouse rejections.

Denial & Audit Response

Medical-necessity, maintenance-care, and AT-modifier denials are appealed with documentation — and if your practice faces a payer or federal audit, we help assemble the records to respond.

FAQ

Frequently Asked Questions

Do you understand Medicare rules for chiropractic billing specifically?▾

Yes. Medicare covers only manual manipulation of the spine to correct a documented subluxation (CPT 98940–98943), with the AT modifier required to attest active treatment. We build claims around that narrow coverage rule and CMS's specific PART documentation standard, rather than a generic billing process.

What is PART documentation, and do you check for it?▾

PART stands for Pain/tenderness, Asymmetry, Range-of-motion abnormality, and Tissue tone/texture/temperature changes — CMS requires at least two of these four, with one being asymmetry or range-of-motion, to establish a billable subluxation. We check every claim against this standard before submission.

Do Medicare Advantage plans cover chiropractic care differently than traditional Medicare?▾

Often, yes. Many Medicare Advantage plans require prior authorization and impose annual visit limits that traditional Medicare does not. We track each plan's specific rules rather than assuming MA patients are billed like traditional Medicare patients.

Can you help us correctly separate active care from maintenance care billing?▾

Yes. This distinction is the single biggest source of chiropractic claim denials and audit risk. We review documentation for functional progress and apply the AT modifier only when active treatment is genuinely supported.

Do you bill for cash-pay maintenance patients as well as insurance-covered active care?▾

Yes. We handle both — patient-pay maintenance visits and insurance-billed active-care visits — and keep the two clearly separated in your billing records.

Do you audit our existing chiropractic billing before we switch?▾

We start every new chiropractic relationship with a billing audit — reviewing denial rate, AT-modifier and PART documentation, A/R aging, and net collection rate — so you know exactly where revenue is leaking before anything changes.

How do you handle accounts receivable and collections?▾

We manage insurance A/R follow-up and patient statement follow-up as part of the billing service — this is not third-party debt collection. Every unpaid claim and aging patient balance is worked on a defined schedule.

Do you work with solo chiropractors, or only multi-doctor clinics?▾

Both. We support solo chiropractors and multi-provider clinics, scaling the billing team to your claim volume and payer mix.

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MedVersify Chiropractic Billing

Billing That Respects Medicare's Narrow Coverage Rule.

Nationwide chiropractic billing support, from solo practices to multi-doctor clinics.

Start With a Free Audit Call (507) 312-9282