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Chiropractic Billing & RCM

Chiropractic billing and revenue cycle, 50-state coverage.

Chiropractic billing and revenue cycle services from ASP-RCM Solutions. 64,839 NPPES chiropractic billing providers across all 50 states + DC. HIPAA + SOC 2 Type II compliant. Senior partners on every account.

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What good chiropractic billing execution looks like.

The operating discipline we install on every chiropractic billing engagement.

  1. CMT code selection by spinal regions (98940-98942)Chiropractic Manipulative Treatment (CMT) codes bill by number of spinal regions: 1-2 (98940), 3-4 (98941), 5 (98942). Chiropractors need region documentation supporting code level.
  2. Active treatment vs maintenance care distinctionMedicare and most commercial payers cover active treatment but not maintenance care. Chiropractors need documentation supporting active treatment medical necessity.
  3. AT modifier and Medicare coverage rulesMedicare requires AT modifier on covered chiropractic services. Lack of AT signals maintenance and triggers denial.
  4. Therapy modality + procedure billingAdjunct therapies (97014, 97032, 97035, 97110, 97140) require separate coding plus appropriate modifiers (59 / X-modifiers) to bypass NCCI bundling.
  5. Massage therapy + dry needling separationMassage (97124) and dry needling (20560-20561) require specific documentation and modifier handling. Some commercial payers cover; many do not.
  6. Workers comp + auto/PIP claim workflowChiropractic practices often work with WC and auto/PIP. State-specific WC fee schedules, attorney communication, and PIP rate variation require dedicated workflow.

Medical necessity and active treatment map

Where a chiropractic claim is actually decided, decision by decision.

A chiropractic episode is not one billing event. It is a chain of five decisions, and four of them are settled inside the treatment room before a claim is ever built. The exhibit below is drawn from the coverage rules that govern the benefit, not from sample data and not from a client.

Chiropractic medical necessity and active treatment map ONE CHIROPRACTIC EPISODE, THE FIVE DECISIONS THAT SETTLE WHETHER IT PAYS DECISION POINTWHAT DECIDES WHETHER IT PAYSIF IT IS DECIDED LATE OR WRONG Initial visit history, exam, and thesubluxation itself A subluxation shown by x-ray or byphysical exam. Two of the four examcriteria, one of which must be asymmetryor range of motion abnormality. The precise level is never named, so theprimary diagnosis cannot carry the claim. Treatment plan written at the outset,not reconstructed later Three elements: recommended level ofcare by duration and frequency, specifictreatment goals, and objective measuresof treatment effectiveness. No baseline measure exists, so improvementcannot be shown when a payer asks for it. Active treatment 98940 to 98942 billedwith the AT modifier Whether the record shows a reasonableexpectation of recovery or improvementof function. AT has been required onevery such claim since October 1, 2004. AT is omitted, and the claim is read asmaintenance therapy and denied. The boundary where active treatmentbecomes maintenance Clinical status stable, with no furtherobjective improvement expected. Care isthen supportive rather than corrective,and AT must come off the claim. AT keeps being applied past the boundary.That is the version a post-payment reviewfinds, later, with the interest attached. Everything else x-rays, therapies andextraspinal work Nothing a payer decides. Medicare Part Bdoes not pay for x-rays or any otherdiagnostic or therapeutic service orderedor furnished by a chiropractor. Those lines are sent to Medicare as thoughthe denial were appealable. It is not acoverage judgment. It is the statute. Four of these five decisions are made in the treatment room, before a claim exists.The fifth was made by statute. There is no appeal that changes it.

Sources for the exhibit: coverage limited to manual manipulation of the spine to correct a subluxation, and no payment for other diagnostic or therapeutic services furnished or ordered by a chiropractor, 42 CFR 410.21(b) and Social Security Act 1861(r)(5) at 42 U.S.C. 1395x(r)(5); subluxation demonstrated by x-ray or physical exam, the treatment plan elements, the acute and chronic subluxation categories, and the maintenance therapy boundary, CMS Medicare Benefit Policy Manual, Pub. 100-02, chapter 15, sections 240.1.2 through 240.1.5; the AT modifier requirement effective October 1, 2004 under CR 3449, CMS Medicare Benefit Policy Manual chapter 15 section 240.1.5 and the CGS Administrators billing and coding guidelines for chiropractic services, L34585.

The rules you are billing under

Six things a chiropractic practice should know cold.

Each item below carries its source. We do not publish benchmarks we cannot point at.

64,839
Chiropractic orgs in NPPES

Chiropractic billing organizations registered across all 50 states and DC. ASP-RCM publishes a field guide for every one of them.

NPPES registry, ASP-RCM specialty universe build
98940 to 98942
The only codes Medicare pays a chiropractor

Medicare Part B pays only for a chiropractor's manual manipulation of the spine to correct a subluxation, where the subluxation has produced a neuromusculoskeletal condition for which manual manipulation is appropriate treatment. Everything else in the room sits outside the benefit.

42 CFR 410.21(b)(1); Social Security Act 1861(r)(5), 42 U.S.C. 1395x(r)(5)
98943
Extraspinal, and never covered

Medicare does not cover chiropractic treatment of extraspinal regions, which the contractor guidance defines as the head, the upper and lower extremities, the rib cage and the abdomen. This is not a medical necessity judgment that can be appealed with a better note. The benefit is written around the spine.

CGS Administrators, Billing and Coding Guidelines for Chiropractic Services, L34585
October 1, 2004
The date AT started deciding claims

Since that date every claim carrying 98940, 98941 or 98942 must include the AT modifier when active or corrective treatment is performed. The modifier must not be applied when maintenance therapy has been provided. Claims without AT are treated as maintenance therapy and denied.

CMS Medicare Benefit Policy Manual, Pub. 100-02, chapter 15, sections 240.1.3 and 240.1.5; CR 3449
2 of 4
Exam criteria to show a subluxation

Where the subluxation is demonstrated by physical examination rather than by x-ray, two of the four criteria are required, and one of those two must be asymmetry or misalignment, or a range of motion abnormality. The other two are pain and tenderness, and tissue or tone change.

CMS Medicare Benefit Policy Manual, Pub. 100-02, chapter 15, section 240.1.2
$33.5675
CY 2026 conversion factor

The qualifying-APM conversion factor for CY 2026. Clinicians not in a qualifying APM are paid on $33.4009. Every unit of chiropractic manipulative treatment RVU passes through one of those two numbers.

CMS CY 2027 Physician Fee Schedule proposed rule impact analysis, 91 FR 43842

Revenue leakage taxonomy

The five places chiropractic revenue actually leaks.

Chiropractic denials are not random. They cluster into five drivers, and four of the five are settled by a decision made before the claim is ever submitted. This is the taxonomy we work against on every chiropractic engagement. Our full treatment of the prevention side is in the denial prevention field manual.

Leakage driverHow the dollars go missingThe pre-bill control we installFixable pre-bill
Subluxation level and diagnosis orderThe claim cannot name what it treatedThe precise level of the subluxation has to be specified and listed as the primary diagnosis, with the neuromusculoskeletal condition necessitating treatment as the secondary diagnosis. A note that records pain without locating it, or a claim that leads with the symptom rather than the subluxation, cannot substantiate a manipulation.A charge entry rule that will not release a manipulation line until the spinal level is named and sequenced first, using the vertebral or regional designations the manual recognizes.Yes
The treatment plan with no measurable goalNothing to show improvement againstThe plan is written as a schedule of visits rather than as a plan. The recommended level of care is there, the specific treatment goals are vague, and there is no objective measure of treatment effectiveness. Months later the practice is asked to demonstrate functional improvement and has no baseline on the same scale to demonstrate it from.A three-element plan enforced at the initial visit: recommended level of care by duration and frequency, specific treatment goals, and a named objective measure repeated at every reassessment on the same instrument.Yes
The AT modifier applied by habitBoth directions cost moneyTwo opposite failures, one taxonomy. AT omitted on genuine active treatment turns a payable claim into a maintenance denial. AT applied to every claim regardless of clinical status keeps paying until a post-payment review reads the notes and reaches the opposite conclusion, and by then the exposure has compounded across a caseload.The AT decision driven by the reassessment record rather than by the billing template, with a pre-bill check that reads the last documented objective measure before the modifier is allowed onto the line.Yes
The maintenance boundary crossed silentlyCorrective becomes supportiveOnce the clinical status has remained stable for a condition, with no expectation of additional objective clinical improvement, further manipulation is maintenance therapy and is not payable. The boundary is real but it is invisible in a schedule of recurring visits, so it is usually crossed without anyone recording that it was crossed.A standing reassessment cadence that forces an explicit call at the point improvement plateaus, with the advance beneficiary notice and the appropriate liability modifier handled at that moment rather than after a denial.Yes
Workers compensation and auto or PIPA different rulebook per fileThese files do not follow group health. Fee schedules, documentation expectations, authorization steps, attorney correspondence and payment timing are set by state law and by the individual policy rather than by a national payer manual, so a single billing workflow applied across all of them produces avoidable underpayment and stalled files.A separate work queue per payer class with the jurisdiction's own fee basis, authorization steps and correspondence loop built in, and file-level follow-up cadence rather than a shared aging bucket.Partly

The table describes ASP-RCM's operating taxonomy and the controls we install. It does not assert denial frequencies. Denial mix is measured per practice during the free 30-day audit against your own last 90 days of claim data. Rows one through four reflect 42 CFR 410.21(b) and CMS Medicare Benefit Policy Manual, Pub. 100-02, chapter 15, sections 240.1.2 through 240.1.5. Workers compensation and personal injury protection rules are set by each jurisdiction, so the fifth row is described as a control rather than as a rate.

Money map

From initial visit to cash posted.

Five stages. Three leak points. Every leak sits upstream of the clearinghouse, which is why chasing chiropractic denials after submission never gets a practice to a clean net collection rate.

Chiropractic claim to cash money map 0102030405 Subluxation and itslevel documented Treatment plan withobjective measures Active treatment,AT applied Reassessed againstthe plan on record Payment posted,cash collected LEAKLEAKLEAK Goals written, but noobjective measure tojudge them against AT applied by habit,not by what the noteactually supports Care runs past theboundary with ATstill on the claim All three leaks sit in the treatment room, upstream of the clearinghouse.Working them there is revenue. Working them after submission is appeals.

Top chiropractic billing markets by NPPES org count.

State-level RCM guides for the largest chiropractic billing markets in the U.S.

Florida5,779 orgs → California5,302 orgs → Texas4,797 orgs → Illinois3,560 orgs → New York2,742 orgs → Pennsylvania2,710 orgs → Michigan2,473 orgs → New Jersey2,392 orgs →

View all 50 state guides →

Chiropractic billing FAQ

Questions chiropractic practice owners actually ask.

What does Medicare actually cover for a chiropractor?

Manual manipulation of the spine to correct a subluxation, and nothing else. Medicare Part B pays only for a chiropractor's manual manipulation of the spine to correct a subluxation where that subluxation has resulted in a neuromusculoskeletal condition for which manual manipulation is appropriate treatment, and Part B does not pay for x-rays or any other diagnostic or therapeutic service furnished or ordered by a chiropractor. That is 42 CFR 410.21(b), and it follows the definition of physician in section 1861(r)(5) of the Social Security Act, which recognizes a chiropractor only with respect to treatment by means of manual manipulation of the spine. A manual device that is hand held, with the thrust controlled manually, may be used, but no separate payment is available for the device.

What does the AT modifier do, and when should it not be used?

The AT modifier tells Medicare that the manipulation being billed is active or corrective treatment rather than maintenance therapy. Since October 1, 2004, under CR 3449, every claim carrying 98940, 98941 or 98942 has to include AT when active or corrective treatment is performed, and a claim without it is treated as maintenance therapy and denied. The rule runs in both directions, which is the part practices miss. AT must not be placed on the claim when maintenance therapy has been provided. Applying it to every visit by template keeps money flowing until a post-payment review reads the notes, and the exposure by then is spread across a whole caseload rather than one claim.

Why is 98943 not covered by Medicare?

Because extraspinal manipulation is outside the benefit rather than inside it and unproven. The contractor guidance states plainly that Medicare does not cover chiropractic treatment of extraspinal regions, which it defines as the head, the upper and lower extremities, the rib cage and the abdomen. The reason sits above the coverage policy: the statute recognizes a chiropractor as a physician only with respect to manual manipulation of the spine, so a service that is not spinal manipulation has no route to payment no matter how well it is documented. Practices can still submit the charge to obtain a denial for a secondary carrier, but it should be planned as a denial rather than expected as a payment.

What has to be in a chiropractic treatment plan?

Three things, and the third is the one that gets left out. The treatment plan should include the recommended level of care, meaning the duration and frequency of visits, the specific treatment goals, and objective measures to evaluate treatment effectiveness. The objective measure is what makes the rest of the record defensible, because the acute and chronic subluxation categories both turn on whether further care can be expected to produce improvement, and improvement cannot be shown without a baseline on the same instrument. A practice that records a schedule of visits and a general goal has documented an intention rather than a plan.

How is workers compensation and auto or PIP billing different from group health?

It is a different rulebook per file rather than a variation on the same one. Fee basis, documentation expectations, authorization steps, attorney correspondence and payment timing are set by state law and by the terms of the individual policy, not by a national payer manual, so the specific rate and the specific form differ by jurisdiction and by carrier. What travels is the operating discipline: these files need their own work queue with the jurisdiction's fee basis and authorization steps built into it, and file-level follow-up rather than a shared aging bucket, because a workers compensation file that sits in a general aging report tends to be worked last and settled worst.

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Chiropractic billing by state.

Dedicated Chiropractic billing and credentialing field guides for 51 states. Each state guide opens into its city-level guides with local payer, Medicaid, and credentialing detail.