Specialty
Chiropractic Medical Billing
Medicare covers one thing in this specialty. Everything else needs an ABN and a different conversation.
What makes chiropractic billing different
Chiropractic has the narrowest Medicare benefit of any specialty on this list: manual manipulation of the spine to correct a subluxation, and nothing else. Examinations, X-rays and modalities performed in the same office are not covered, however clinically appropriate they are.
The other half of the problem is active treatment versus maintenance. The AT modifier attests that care is corrective rather than supportive. Applied indiscriminately it is an audit exposure; omitted where warranted, the claim denies as maintenance.
AT modifier and maintenance care
Active treatment must be documented with a treatment plan showing expected improvement. Care that has plateaued is maintenance and is not covered.
Region count drives the code
98940, 98941 and 98942 differ by spinal regions treated. The regions must be documented individually, not implied.
Non-covered services and ABNs
Exams, X-rays and modalities need an Advance Beneficiary Notice signed before the service, not billed after it.
E/M on the same visit
A separately identifiable evaluation alongside manipulation needs modifier 25 and a note that would stand up without the manipulation in it.
Ask any billing company this
“How many of my claims went out without an AT modifier last quarter?”
A company that bills your specialty properly will answer this in one sentence. A company that treats every specialty the same will answer it with a brochure.A note on accuracy. Coding rules, coverage policies and payer edits change continually, and the specifics above reflect general practice rather than any individual payer contract or local coverage determination. Treat this page as a map of where to look, not as coding advice for a particular claim.