Chiropractic practices face some of the toughest billing restrictions in healthcare. From limited insurance coverage and strict medical necessity rules to documentation-intensive coding, chiropractors must follow extremely specific billing guidelines to get paid accurately and on time.
Chiropractic Medical Billing Services
At Smart RCM Solutions, we help chiropractic providers streamline billing, reduce denials, and increase collections — so you can stay focused on helping patients without worrying about lost revenue.
Common Challenges in Chiropractic Billing
- Medicare limits coverage to spinal manipulation only (CPT 98940–98942)
- Medical necessity must be supported with proper documentation and treatment plans
- Frequent denials due to lack of supporting progress notes
- Limited reimbursable services (many therapeutic procedures are not covered)
- Confusion over diagnosis coding and allowable visits
- Payer-specific differences for commercial vs. federal programs
- High patient responsibility (copays, deductibles, non-covered care)
Chiropractic billing demands both coding accuracy and aggressive A/R follow-up — especially with insurance plans that closely scrutinize claims.
Our Chiropractic Billing Services Include:
✅ Chiropractic-Specific Coding & Modifiers
We apply proper CPT codes (98940–98942) and modifiers like AT, GA, and GZ based on patient condition, maintenance vs. active care, and payer requirements.
✅ Medicare & Commercial Claims
We manage your Medicare documentation and navigate different commercial payer rules to help you get maximum reimbursement with minimal hassle.
✅ Detailed Documentation Review
We guide your team in producing compliant SOAP notes and treatment plans that justify medical necessity.
✅ Denial Management & Appeals
If claims are denied or underpaid, we respond immediately with corrections, resubmissions, and appeals backed by clinical evidence.
✅ Patient Statements & Collections
We help reduce outstanding balances with timely patient billing, friendly reminders, and digital payment solutions.
CPT Codes Commonly Used in Chiropractic Billing
- 98940 – Spinal manipulation (1–2 regions)
- 98941 – Spinal manipulation (3–4 regions)
- 98942 – Spinal manipulation (5 regions)
- 97012 – Mechanical traction
- 97110 – Therapeutic exercises
- 97140 – Manual therapy techniques
- G0283 – Electrical stimulation (Medicare)
- S8990 – Wellness or maintenance care (non-covered)
We also help you use AT Modifier correctly for active treatment and manage GA/GZ modifiers for maintenance care as required by Medicare.
Who We Work With
- Solo Chiropractors
- Multi-location Chiropractic Clinics
- Integrated Practices (Chiro + PT/Ortho)
- Sports Injury & Wellness Centers
- Cash & Insurance-Based Chiropractors
- Functional Medicine and Rehab Clinics
Whether you’re billing Medicare, BCBS, Aetna, Cigna, United, or others — we ensure your chiropractic billing process is customized, compliant, and profitable.
Why Chiropractors Choose Smart RCM Solutions
🔍 Deep knowledge of chiropractic coding & regulations
💻 Fast EHR integration and claims processing
📉 Reduced denials with accurate documentation checks
📈 Increased cash flow and faster reimbursements
📊 Detailed monthly reports and financial insights
👥 Friendly, U.S.-oriented team with 24–48 hr turnaround
We don’t just manage your claims — we build a revenue system that supports long-term growth.
Chiropractic Billing FAQs
Q: Can chiropractors bill Medicare for maintenance care?
No, Medicare only reimburses spinal manipulation for active treatment. Maintenance care must be reported with GA or GZ modifiers and is not reimbursed.
Q: What does the AT modifier mean?
The AT modifier is used to indicate that a spinal manipulation service is for active treatment. Without it, Medicare will automatically deny the claim.
Q: Can I bill 97110 or 97140 with an adjustment?
Yes, but only with clear documentation of separate and distinct procedures, and usually by appending modifier 59 to avoid bundling issues.
Q: What happens if my claim is denied for “not medically necessary”?
We audit the notes, identify documentation gaps, and resubmit or appeal with corrections and medical evidence to support the claim.
Let Us Optimize Your Chiropractic Billing
At Smart RCM Solutions, we understand the unique rules that govern chiropractic billing. From navigating Medicare’s tight coverage rules to maximizing commercial reimbursements — we help chiropractors stay compliant, profitable, and patient-focused.
📞 Call us: +1-725-245-5971
📩 Email: [email protected]
🌐 Website: www.SmartRCMSolutions.com