Specialty
Chiropractic Billing and RCM
Medicare covers one thing. Everything else needs a conversation before the visit, not after.
Why it’s different
Medicare covers manual manipulation of the spine to correct a subluxation — and nothing else a chiropractor does. Exams, x-rays, therapies and modalities are statutorily excluded, however clinically appropriate they are.
The AT modifier separates active treatment from maintenance care, and maintenance care is not covered. Practices that don't use ABNs correctly absorb the difference themselves.
Common challenges
Where the money goes missing.
- AT Modifier
- Missing on active treatment, or wrongly applied to maintenance care.
- Excluded Services
- Statutorily excluded services billed to Medicare without an ABN on file.
- Subluxation Documentation
- Records that don't establish a subluxation or an active treatment plan.
- Commercial Visit Caps
- Plan visit limits reached mid-treatment with no notice to the patient.
- Bundled Modalities
- Therapies and modalities absorbed into the manipulation code.
How we help
We check AT modifier use against the documented treatment plan, make sure ABNs are in place before excluded services are delivered, and track commercial visit limits so patients know where they stand before the cap is hit.
We do not provide coders. Your clinical team assigns the codes. We verify and validate them.
Key codes
- CPT 98940–98942
- Modifier AT
- Modifier GA / GY
- ABN (Form CMS-R-131)
Indicative, not exhaustive. Code sets and payer policies change.
Get a Chiropractic Billing Analysis
Send us a sample of your denials. We'll tell you what's actually driving them in your specialty.