What makes chiropractic billing services different
Chiropractic billing services revolve around one code family — spinal manipulation, 98940 through 98942 — and one modifier, AT, that decides whether Medicare pays. Medicare covers manipulation to correct a subluxation when the care is active and corrective, and excludes maintenance care entirely. Most commercial plans add their own visit limits, medical-necessity reviews and documentation rules. Fastora's certified billing and coding professionals handle these claims for chiropractic practices as part of our wider medical billing services.
Chiropractic practices also bill outside health insurance more than most specialties: auto accident cases, workers' compensation and personal-injury liens each follow different rules, different payers and different timelines. The practice management system has to keep the case types separate so health plan claims never mix with liability billing.
Chiropractic coding: key codes and the AT modifier
| Code | Descriptor (summary) | Billing note |
|---|---|---|
| 98940 | Chiropractic manipulative treatment, 1-2 regions | Region count in the note |
| 98941 | Chiropractic manipulative treatment, 3-4 regions | Region count in the note |
| 98942 | Chiropractic manipulative treatment, 5 regions | Maximum region count |
| 97140 | Manual therapy techniques | Distinct from CMT; needs separate documentation |
| 97110 | Therapeutic exercises | Time-based; minutes documented |
| 97035 | Ultrasound, each 15 minutes | Time-based modality |
| 99202-99215 | Office/outpatient E/M | New patient exam or re-exam with separate problem |
The AT modifier marks a chiropractic service as active or corrective treatment rather than maintenance. On Medicare claims the AT modifier on the manipulation code is what makes the service payable — without it, Medicare treats the service as maintenance and denies it as not covered.
Therapies billed alongside manipulation need their own documentation: the technique, the body region, the time spent and the clinical reason distinct from the manipulation itself. Our medical coding team reviews chiropractic claims against the daily notes before submission.
Medicare rules: active treatment vs maintenance care
Medicare's rule is straightforward in principle: it pays for manipulation that is expected to correct a subluxation and improve function, and it does not pay for maintenance — care intended to prevent deterioration or preserve current function without expectation of improvement. The note must show the subluxation, the treatment plan with measurable goals, and progress toward those goals.
When care becomes maintenance, the practice should have the patient sign an Advance Beneficiary Notice and bill with the GA modifier so the balance can go to the patient. Billing maintenance care to Medicare as if it were active treatment is one of the most common chiropractic audit findings, so we flag the transition point in the documentation rather than letting it drift.
Personal injury and workers' compensation billing
Auto accident and workers' compensation cases are billed to the auto carrier, the employer's comp carrier or a letter of protection — not to the patient's health plan. Fee schedules, authorization requirements and documentation standards differ by state and by carrier, and personal-injury balances may not resolve until a case settles.
We keep liability and comp cases in separate workflows with their own follow-up schedules, so a slow-settling PI case never blocks the health-plan AR, and health-plan claims never accidentally go to an auto carrier.
Eligibility checks before care plans
We run eligibility and benefits checks before care plans begin, confirming visit limits, medical-necessity review thresholds and whether the plan requires the AT modifier or its own maintenance-care attestation. Many plans cap annual chiropractic visits, and the count resets by plan year, not calendar year.
Care plans that exceed the plan's visit limit without an approved extension will deny visit by visit. We track visit counts against each plan's limits and flag when an extension or re-evaluation is needed before the next visit.
Common chiropractic billing denials and how we prevent them
| Denial | Typical cause | Prevention step |
|---|---|---|
| Maintenance denial | AT modifier missing or care documented as maintenance | Active-care criteria and AT use reviewed per claim |
| Visit limit exceeded | Plan's annual cap reached without extension | Visit counts tracked against each plan's limits |
| Therapy bundled | 97140 or 97110 billed without distinct documentation | Separate technique, region and time documented |
| E/M denied with CMT | No separately documented problem for the exam | Re-exam notes reviewed before the E/M is added |
| No subluxation documented | Medicare requires the subluxation in the record | Subluxation, plan and goals verified at intake |
Every claim passes our Advanced Pre-Submission Claim Review before submission. Denials that still occur are worked by our denial management team, which corrects and resubmits or appeals with the record, and open balances are followed up by payer and age.
Credentialing for chiropractors
Chiropractors enroll with Medicare and commercial plans as physicians, and new associates need to be linked to the group before their claims pay in network. Some plans credential chiropractors through limited panels with closed enrollment periods, which makes timing the application important.
Our credentialing and enrollment service tracks each file through a nine-stage process, from document collection and NPI and CAQH setup to payer applications, follow-ups and final approval.
How Fastora supports chiropractic billing
Fastora works inside your existing EHR/PM system under the user access you grant, with no software to install and no hidden setup fees. You get a dedicated account contact, transparent dashboards, monthly performance reporting and a monthly review call.
Fees are quoted after a free assessment, and you can read how our pricing models work beforehand. To see how your current claims hold up, start with a free billing assessment.
Chiropractic billing and coding services
Chiropractic billing and coding starts with the visit structure: spinal manipulation codes, timed therapy codes, and the documentation payers require for medical necessity. Chiropractic medical billing means visit-limit tracking, maintenance-care rules, and Medicare's specific coverage limits for chiropractic services. Chiropractic insurance billing covers the verification behind every visit — active coverage, visit counts used, and whether the plan excludes maintenance care — so the claim is built on facts, not assumptions. Maintenance-care and AT-modifier denials are worked through our denial management service.
Chiropractic billing companies and chiropractor credentialing
Practices comparing a chiropractic billing company should look for specialty volume: how many chiropractic claims they handle daily, and whether they can describe your top denial reasons without guessing. A chiropractic billing services company should show how it handles visit limits, bundled-code edits, and cash-versus-insurance patients in one workflow. Chiropractor billing services from Fastora cover claims, denials, A/R, and patient balances in a single engagement — with payment accuracy checked against your contracts. See our payment posting process.
Chiropractor credentialing runs alongside the billing: CAQH profile setup and attestation, NPI registration, and payer panels tracked per provider with revalidation dates on a calendar. Many practices outsource chiropractic billing together with credentialing, so a new associate can bill from day one instead of waiting on paperwork. Our credentialing and enrollment team handles it start to finish and a free medical billing audit shows what your claims are missing today.