Chiropractic Billing Services

Chiropractic billing depends on a few codes used over and over, which makes each payer's rules matter even more. Spinal manipulation is billed by the number of regions treated, and Medicare covers only a narrow set of services. Anything else may be the patient's responsibility, and mixing the two takes care.

Chiropractic practices also see auto injury and personal injury cases, where claims move on a different track than health insurance. Westmont connects chiropractors with vetted billing experts who understand chiropractic billing from front desk to appeal. They help with eligibility checks, clean claims, and documentation habits that stand up to payer review, so your clinic is not caught off guard by records requests.

Who this is for

• Solo chiropractors and small clinics
• Multi-provider and multi-location chiropractic groups
• Integrated clinics that offer therapy, massage, or acupuncture
• Chiropractors who treat auto accident and personal injury patients
• Practices that accept Medicare and Medicare Advantage plans
• Wellness-focused clinics with a mix of insurance and cash patients

What gets billed

• Chiropractic manipulative treatment of the spine, by number of regions
• Manipulation of regions outside the spine
• New and established patient evaluation and management visits
• Spinal x-rays taken in the office
• Mechanical traction
• Massage and soft tissue work
• Manual therapy
• Therapeutic exercise and neuromuscular re-education
• Electrical stimulation
• Supplies and braces, where payers allow

Commonly billed codes

Code	Type	What it covers
98940	CPT	Spinal manipulation, one to two regions
98941	CPT	Spinal manipulation, three to four regions
98942	CPT	Spinal manipulation, five regions
98943	CPT	Manipulation of areas outside the spine
99203	CPT	New patient office visit, low-level decision-making
99213	CPT	Established patient office visit, low-level decision-making
72100	CPT	Lumbar spine x-ray, two or three views
97012	CPT	Mechanical traction
97124	CPT	Massage, each 15 minutes
97140	CPT	Manual therapy, each 15 minutes
AT	Modifier	Marks active treatment on Medicare spinal manipulation claims
25	Modifier	Marks a separately identifiable E/M service on the same day as a procedure
M99.01	ICD-10-CM	Segmental and somatic dysfunction, cervical region
M54.2	ICD-10-CM	Neck pain
M54.50	ICD-10-CM	Low back pain, unspecified

Note

Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.

Billing challenges in chiropractic care

Medicare's narrow coverage. Medicare generally covers manual manipulation of the spine for specific problems, and not other services a chiropractor may perform. Billers learn what to submit and what requires patient notice.

Region counting. The manipulation code depends on how many spinal regions were treated. Billers check that notes list each region and that the diagnosis supports each one.

Modifier use. The AT modifier on Medicare claims signals active treatment, and modifier 25 marks a separate E/M visit. Using either without support is a common audit trigger.

Maintenance versus active care. Payers often deny care they see as maintenance. Notes should show functional goals, progress, and a reasonable end point so the biller can defend medical necessity.

Visit limits and authorizations. Many commercial plans cap chiropractic visits or require authorization after a set number. Tracking limits protects the clinic from unpaid visits.

Auto and injury claims. These cases involve letters of protection, payment from auto carriers, or attorney involvement, with longer timelines. Billers keep these accounts separate and follow up on a schedule.

Records requests. Chiropractic is often a target of payer review. Billers help organize records and respond within deadlines.

How Westmont can help

• Matching your clinic with vetted billing experts experienced in chiropractic billing
• End-to-end revenue cycle support, from eligibility to payment posting
• Denial management and appeals for medical necessity issues
• Help with payer credentialing and enrollment
• Support separating health plan claims from injury and cash accounts

Frequently asked questions

Does Medicare cover chiropractic care?

Medicare generally covers manual manipulation of the spine to correct a subluxation, when it is medically necessary. It generally does not cover other services ordered or provided by a chiropractor, such as exams or x-rays billed to Medicare. Check current Medicare guidance and your contractor's policies before billing.

What is the difference between 98940, 98941, and 98942?

They are chosen by the number of spinal regions manipulated. 98940 is for one to two regions, 98941 for three to four, and 98942 for five. Documentation should show which regions were treated and why, since payers may reduce the code if the notes do not support it.

When should I use modifier 25 with an evaluation visit?

Use it when a separately identifiable evaluation and management service is provided on the same day as manipulation, beyond the usual pre-treatment assessment. The note should clearly show the extra work. Overuse is a common audit target, so billers review notes before adding it.

Why do chiropractic claims get denied?

Common reasons include visit limits, lack of authorization, notes that suggest maintenance care, missing modifiers, and diagnoses that do not support the number of regions. A chiropractic billing company can find the patterns and fix the process, not just resubmit claims.

Can you help with auto accident and personal injury cases?

Many billing experts handle these accounts, which follow different rules from health insurance. Tell us how often you see them and which states you work in. We will look for experts who understand your cases.

Related billing services

• Physical Therapy
• Acupuncture
• Personal Injury & Auto Accident
• Pain Management
• Sports Medicine
• Workers' Compensation Providers