Specialty billing by BilNow
Billing for chiropractic practices
Chiropractic Billing Services
BilNow bills chiropractic claims for CMT codes 98940 to 98943, the Medicare AT modifier, and auto and injury cases. The region count, the subluxation findings and the modifier have to agree with the note before a claim goes out. Chiropractic billing costs 2.7% of collections, with no setup fee and no long-term contract.
Chiropractic is one of the 50+ specialties BilNow bills, for 300+ providers in total.
Reviewed October 2026.
- 98% first-pass claim rate
- Denials under 5%
- HIPAA-trained team
- Call (718) 701-8169
Why a chiropractic-specific biller
Chiropractic billing services begin with the one service Medicare pays for
Our chiropractic billing services start from a rule that shapes every claim: under the Medicare Benefit Policy Manual, chapter 15, section 240, Medicare treats a chiropractor as a physician only for manual manipulation of the spine to correct a subluxation. Evaluations, therapy, supplements and x-rays ordered by the chiropractor are not covered by Medicare. We also bill Medicare Advantage, commercial plans, auto accident and personal injury cases, and workers compensation.
The check: the CMT code, the spinal regions, the AT modifier and the diagnosis have to agree with the note. A mismatch turns into a question for your clinic before release.
For help beyond chiropractic, see our revenue cycle management services and denial management services.
CMT codes and Medicare modifiers
98940, 98941 and 98942 by spinal regions treated, 98943 for extraspinal regions, and the AT, GA and GZ modifiers that decide whether Medicare pays.
Subluxation documentation
PART findings, the level of subluxation, the plan of care and the objective measures that show active treatment.
Injury and commercial payers
Auto, personal injury and workers compensation payer order, plus commercial visit limits and authorization.
How it works
How do chiropractic billing services move a claim from visit to payment at BilNow?
A chiropractic claim passes seven stops between the visit note and the posted payment. The table after the steps lists what we do at each stop and what you see.
From visit to payment
- 01
Intake and payer order
Confirm whether health insurance, auto, med pay or workers compensation pays first.
- 02
Benefits and visit caps
Check benefits, copays, visit caps and authorizations before the visit.
- 03
Note review
Read the exam findings, PART items and subluxation level in the visit note.
- 04
CMT code and AT
Set 98940 to 98943 by the regions documented, then AT, GA or GZ.
- 05
Region check
Compare regions billed with regions documented before the claim leaves.
- 06
Release and posting
Send the clean claim, then post payments against the expected amount.
- 07
Denials and plateau flags
Work denials by cause and flag plateaued patients for an updated plan of care.
Our work and your view on a chiropractic claim
Codes and modifiers
Which CPT codes and modifiers do chiropractic billing services handle?
These are general descriptions of the codes our chiropractic claims use most. CPT counts five spinal regions for CMT: cervical, thoracic, lumbar, sacral and pelvic. The manual's own list of spinal areas for the subluxation level is worded slightly differently, so the level on the claim must come from the note. Check the current CPT book for full descriptors, and see our CPT modifiers cheat sheet for modifiers across specialties.
Chiropractic manipulative treatment (CMT) codes
| CPT code | Description | Regions | Billing note |
|---|---|---|---|
| 98940 | Chiropractic manipulative treatment (CMT), spinal | 1 to 2 regions | Medicare covers spinal manipulation to correct a subluxation, with the AT modifier when the care is active treatment. |
| 98941 | Chiropractic manipulative treatment (CMT), spinal | 3 to 4 regions | Same Medicare rules as 98940. The regions billed must match the regions documented. |
| 98942 | Chiropractic manipulative treatment (CMT), spinal | 5 regions | Same Medicare rules as 98940. The note needs to show each of the five regions treated. |
| 98943 | Chiropractic manipulative treatment (CMT), extraspinal | 1 or more regions | Outside Medicare's spinal manipulation benefit, so Medicare does not cover it. Some commercial and injury payers pay it. |
Active treatment versus maintenance: AT, GA and GZ
Section 240.1.3 splits spinal joint problems into acute and chronic subluxation. Care is active when it is expected to improve or arrest the condition. Once the clinical status is stable with no expected objective improvement, further manipulation is maintenance therapy and is not covered.
| Modifier | When it applies | Effect on the claim |
|---|---|---|
| AT | Active or corrective treatment of an acute or chronic subluxation. | Required on Medicare chiropractic claims for active care. Contractors may still deny after medical review. |
| No AT | Maintenance therapy. | The manual says claims without AT are considered maintenance therapy and are denied. |
| GA | An ABN was issued and is on file for care that may be maintenance. | A denial is expected, and the patient can be billed under the ABN rules. |
| GZ | A denial is expected and no ABN is on file (rare, per the manual). | Generally the clinic cannot bill the patient for the denied service. |
| 25 | A significant, separately identifiable E/M visit on the same day as a CMT. | Lets a covering payer pay the E/M with the CMT. Medicare does not pay chiropractors for E/M. Needs its own documented problem and decision. |
| GP / 59 / XS | Therapy under a plan of care (GP), or a distinct service an edit would bundle (59 or XS). | Required by some commercial payers on therapy codes. Added only where the note supports it. |
Why this matters: a plateaued patient billed with AT is an audit risk, and a plateaued patient billed without an ABN becomes provider liability. We flag patients whose notes show no objective gain, so the plan of care is updated or an ABN is signed before the next visit.
Documentation: PART findings, diagnosis and x-ray rules
Section 240.1.2 defines subluxation as a motion segment in which alignment, movement integrity or physiological function of the spine is altered although contact between joint surfaces remains intact. It can be shown by x-ray or by physical examination. The four exam criteria are commonly remembered as PART.
| Letter | Criterion in the manual | What the note should show |
|---|---|---|
| P | Pain or tenderness | Location, quality and intensity |
| A | Asymmetry or misalignment | Identified at a sectional or segmental level |
| R | Range of motion abnormality | Changes in active, passive and accessory joint movement |
| T | Tissue or tone changes | Skin, fascia, muscle and ligament findings |
- Two of four. Two of the four criteria are required, and one of them must be asymmetry or misalignment, or range of motion abnormality.
- Initial visit. History, description of the present illness, physical examination, a primary diagnosis of subluxation with its level, a treatment plan with level of care, goals and objective measures, and the date of initial treatment.
- Subsequent visits. Review of the chief complaint and changes since the last visit, exam of the area involved, assessment of change in condition and treatment effectiveness, and the treatment given that day. Symptoms must relate to the level of subluxation cited; a statement of simply "pain" is insufficient.
- X-rays and treatment parameters. An x-ray is not required for dates of service on or after January 1, 2000. If one is used, the manual treats it as reasonably proximate when taken no more than 12 months before or 3 months after treatment starts. Section 240.1.5 says acute problems may require as many as three months of treatment, with frequency decreasing as the patient improves.
The Medicare source is Medicare Benefit Policy Manual, chapter 15, sections 240 to 240.1.5. We review every note against these requirements before the claim is submitted.
Additional CMS source: the Medicare Claims Processing Manual, chapter 12, which covers physician and practitioner billing, including chiropractic services.
Denials
Which denials do chiropractic billing services see most, and how are they fixed?
Most chiropractic denials trace back to a missing or misplaced modifier, thin subluxation documentation, a visit cap, or the wrong payer on an injury claim. Every row lists a pattern, its usual cause and our fix. Use our denial code lookup to decode a CARC or RARC on a remit, and check each plan deadline on the timely filing limits page.
| Denial pattern | Typical cause | What we do about it |
|---|---|---|
| Missing or wrong AT modifier | AT left off active care, or placed on maintenance care. | We check AT, GA and GZ against the note before submission. |
| Maintenance care billed as active | Patient plateaued with no objective improvement. | We flag plateaus so the plan of care is updated or an ABN is obtained. |
| Subluxation not supported | Fewer than two exam criteria, no level on the diagnosis, or regions billed beyond those documented. | We template the exam and diagnosis, and compare regions billed with regions treated. |
| E/M or therapy bundled | No separately identifiable service, or no modifier. | We add modifiers only where the note supports them. |
| Visit cap or authorization | Visits exceeded the plan limit. | We track visits used and request more with updated findings. |
| Wrong payer on injury claims | Health plan billed when auto, med pay or workers compensation was primary. | We confirm payer order and claim numbers at intake. |
How do your own denials compare with these rows? A clean superbill template also helps capture regions and modifiers at checkout.
Payer notes
Payer, state and authorization rules that change a chiropractic claim
These are general notes. Rules differ by payer, plan and state, which is why we check them per patient and per payer.
| Payer type | What to check | How we handle it |
|---|---|---|
| Medicare and Medicare Advantage | Spinal manipulation only, AT on active care, ABN for possible maintenance care, and the contractor policy. | Notes are reviewed against the manual before submission; AT, GA and GZ are set from the note. |
| Commercial plans | Annual visit caps, a separate benefit administrator, copays, and authorization or documented improvement for more visits. | Benefits and limits are verified before the first visit, visits are tracked, and more are requested before the cap. |
| Auto accident (PIP, no-fault, med pay) | State and policy rules, and whether the health plan is primary, secondary or excluded. | Coverage order and claim numbers are confirmed at intake, and charges are itemized with the accident date. |
| Personal injury and letters of protection | Payment depends on the case outcome. | Each balance is tracked to settlement. |
| Workers compensation | Employer carrier, claim number, plan of care and progress reports, plus the state fee schedule and approval rules. | Claims go to the carrier with the required reports, billed to the state schedule. |
- Evaluation, therapy and other services. Medicare pays a chiropractor only for spinal manipulation, so evaluation and management, therapy and other services are not payable by Medicare. Other payers differ. Some allow an evaluation on the same day when a separately identifiable service is documented, and some allow timed therapy codes. We check each contract and do not assume Medicare's limits apply to a commercial plan.
- Credentialing and authorization. Each doctor must be enrolled with each plan, which our medical credentialing services team tracks. For prior authorization where a plan requires it, see our prior authorization services.
- Related spine care. Where chiropractic overlaps with spine care or therapy, see our orthopedic billing services and physical therapy billing services.
- State notes. Medicare rules apply nationwide, but contractor policies, state workers compensation fee schedules and auto coverage rules differ. We bill for chiropractic clinics in states including New York, Texas, Florida and California, and keep a payer sheet for each account.
Compare the options
Are chiropractic billing services better than in-house or software-only billing?
Chiropractors often ask whether they need a billing service, a biller on staff, or just better billing software. Software is a tool your staff operates. A billing service is a team that does the work, usually inside the software you already own. The table compares the three on the points that decide how much revenue reaches the bank.
| Factor | In-house biller | Software only | BilNow service |
|---|---|---|---|
| Who does the work | One or two staff members enter charges, send claims and chase denials. | Your front desk or office manager runs the software. | Our team handles charge review, claim submission, posting and denial follow-up. |
| Medicare AT, GA and GZ rules | Depends on that person knowing when each modifier applies. | The software may prompt for a modifier, but someone must know when it applies. | We check each note for active-care support and flag patients whose notes show no objective gain before the next visit. |
| Note-to-code check | A careful biller can compare the note to the CMT code and regions. | Scrubbers catch format and missing-field errors; a clinical mismatch between note and code can still pass. | A biller compares the note to the CMT code, regions and diagnosis before the claim goes out. |
| Denials and appeals | Worked when time allows. | The software shows the denial; your staff decides what to do and when. | Each denial is coded to a reason, corrected or appealed and tracked until it is paid. |
| Payment posting and A/R | Posted and followed up around other duties. | Manual posting and aging reports reviewed when staff have time. | Payments posted and aged balances worked on a set schedule, with reports you can read. |
| Coverage and training | Sick days, turnover and retraining on payer and Medicare rules. | Depends on staff skill and training. | A trained team that stays current on payer and Medicare rule changes. |
| How you pay | Salary, benefits and training. | Subscription or license fees, plus the staff time to run it. | 2.7% of collections, with no setup fee and no long-term contract. |
| Your EHR | Works in the EHR you have. | You are limited to the software you picked. | We work inside more than 100 EHRs, so you keep your current system. |
Software or an in-house biller can be enough for a solo doctor with a light payer mix and a staff member who knows Medicare chiropractic rules well. A billing service tends to pay off when claims are piling up, denials are not being worked, or Medicare maintenance-care rules and auto accident cases are creating rework. Many clinics use both: the software for scheduling and notes, and a billing service for the claims. For a wider view, see our guide to outsourcing medical billing.
Control
What a chiropractic clinic approves before BilNow acts
Add AT, GA, GZ or 25 to clear an edit
If the note does not support the modifier, we send a query. We do not add it to get past the edit.
Bill a patient after a GA or GZ denial
A patient balance after an ABN denial is shown to you first. You decide what the patient is asked to pay.
Appeal with a finding the doctor never charted
An appeal quotes the exam findings as charted. We do not add a finding the doctor did not record.
Measurement
What BilNow measures beyond chiropractic
BilNow's 98% first-pass rate, denials under 5% and 95% recovery are whole-service figures, not chiropractic-only numbers. Fees for a chiropractic clinic are on the pricing page.
Onboarding
Onboarding for a chiropractic clinic keeps your EHR
A chiropractic clinic keeps its EHR, since BilNow works inside 100+ of them. The 300+ providers we serve work in 50+ specialties; see billing by specialty.
- 1Share recent chiropractic claims. Send a few recent claims together with their modifier use and denials.
- 2BAA in place. We sign a HIPAA Business Associate Agreement before any visit note or patient detail reaches us.
- 3Connect your EHR. We work inside the software you use. If a doctor needs payer enrollment, our medical credentialing services team takes it on.
- 4Review the first claims. Eligibility and visit-limit checks begin, and we go over region counts and modifiers on the first claims with you.
- 5Monthly reporting. A monthly report covers collections, denials by cause and visits used against plan limits.
How much do chiropractic billing services cost?
Chiropractic billing services cost 2.7% of what the clinic collects. A clinic owes no setup fee and no long-term contract. Ask how the rate works with a mix of Medicare, cash and injury cases.
- No setup fee
- No long-term contract
FAQ
What do chiropractors ask about chiropractic billing services?
What do chiropractic billing services include?
Chiropractic billing services cover eligibility and visit-limit checks, coding review, claim submission, payment posting and denial follow-up for chiropractic clinics. For Medicare, that means checking the AT modifier against the note, matching the CMT code to the spinal regions documented, and routing injury cases to the right payer. See our denial management services.
What does Medicare cover for chiropractors?
Medicare covers only manual manipulation of the spine to correct a subluxation. The Medicare Benefit Policy Manual, chapter 15, section 240, says no other diagnostic or therapeutic service furnished by a chiropractor or ordered by one is covered, including x-rays the chiropractor orders, takes or interprets.
Which CPT codes are used for chiropractic manipulation?
Chiropractic manipulative treatment is reported with 98940 for one to two spinal regions, 98941 for three to four regions and 98942 for five regions. 98943 is for extraspinal regions. Medicare's benefit is limited to manipulation of the spine, so Medicare does not cover 98943, though some other payers do. Our CPT modifiers cheat sheet covers the modifiers used with these codes.
What is the AT modifier and when do I use it?
For Medicare, section 240.1.3 of the manual says a chiropractor must place the AT modifier on a claim when providing active or corrective treatment for an acute or chronic subluxation. It must not be used when the care is maintenance therapy, and claims without AT are treated as maintenance and denied.
What are GA and GZ on chiropractic claims?
When care may be maintenance and not covered, the Medicare Claims Processing Manual rules for the Advance Beneficiary Notice (ABN) apply. GA reports that an ABN is on file, so a denial is expected and the patient can be billed under the ABN rules. GZ reports that a denial is expected and no ABN was obtained, so the clinic generally cannot bill the patient for the denied service.
How is a subluxation documented for Medicare?
It can be shown by x-ray or by physical examination. By exam, two of four criteria are required, and one must be asymmetry or misalignment, or range of motion abnormality. The four are pain or tenderness, asymmetry or misalignment, range of motion abnormality, and tissue or tone changes, often remembered as PART. An x-ray is not required.
When must the x-ray have been taken?
If an x-ray is used, the manual says it is reasonably proximate if taken no more than 12 months before or 3 months after the start of a course of chiropractic treatment. In chronic cases such as scoliosis an older x-ray may be accepted, and a prior CT or MRI that shows the subluxation is acceptable.
How are auto accident, personal injury and workers compensation claims handled?
These cases depend on the payer and on state rules. We confirm which coverage is primary, itemize charges by CPT code with accident dates, track letter of protection balances through settlement, and bill workers compensation carriers with the claim number and required reports. See our personal injury billing services.
How much do chiropractic billing services cost?
The fee for chiropractic billing is 2.7% of collections. Setup is free of charge, and the clinic is not tied to a long-term contract. BilNow works inside 100+ EHRs, so your clinic keeps its current system, and a walkthrough covers your modifier use, denial reasons and open A/R.
Why practices choose BilNow
Book a walkthrough
Work with a chiropractic billing service that reads the note first
Book a 20-minute walkthrough
Bring a recent chiropractic claim or denial and we will show how we would code, scrub and bill it, including how AT, GA and GZ would be set from the note. Our rate for chiropractic clinics is 2.7% of collections.
- 2.7% of collections
- No setup fee
- No long-term contract
Prefer to talk? Call (718) 701-8169.
Related BilNow resources
- Physical therapy billing services
- Personal injury billing services
- Orthopedic billing services
- Urology billing services
- Cardiology billing services
- Mental health billing services
- Medical billing audit services
- Denial management services
- Medical credentialing services
- CPT modifiers cheat sheet
- AI medical billing
- Denial code lookup
- Pricing
Updated October 2026. Code descriptions follow AMA CPT. Medicare policy and contractor articles change, so confirm the current rule before billing.