Chiropractic billing for solo and group practices: Medicare claims with the AT modifier and the documentation to support it, commercial plans with visit limits, and personal injury, auto and workers’ compensation cases, worked inside the software you already use by a US-based team.
Chiropractic billing services turn each visit into a paid claim. Benefits and visit limits are checked before the patient is seen, the adjustment and any therapies are coded to the regions the note documents, the claim goes to the right payer with the right modifiers, and every payment, denial and patient balance is followed until it is resolved.
30.4%
of Medicare payments for chiropractic services were improper in CMS’s 2025 review, against 6.55% across Medicare fee-for-service as a whole
89.5%
of those chiropractic errors were insufficient documentation
Chiropractic is billed differently from almost every other specialty. Medicare pays a chiropractor for one service, manual manipulation of the spine to correct a subluxation, and only while the care is active. Commercial plans cap visits and bundle same-region therapies into the adjustment. Personal injury and auto cases pay months later, from a policy or a settlement, and only if the file is complete.
The note carries the claim. That is why our billing starts with it: when a note does not support the code, we tell you before the claim goes out, not after it is denied.
Most chiropractic practices bill three ways in the same week, often for the same adjustment. Each payer pays for different services, on a different clock, and each one fails in its own way. Here is where each breaks, and what we do about it.
Pays forSpinal manipulation (98940 to 98942) to correct a subluxation, while care is active. Nothing else a chiropractor provides.
Where it breaks
What we do
Pays forAdjustments, exams and therapies, up to the plan’s yearly visit limit and within its authorization rules.
Where it breaks
What we do
Pays forCare after an accident or a work injury, paid by an auto policy, an employer’s carrier or a settlement, each on its own clock.
Where it breaks
What we do
Medicare does not require an X-ray to show a subluxation. A physical exam can, if the note documents two of the four PART findings: pain or tenderness, asymmetry or misalignment, range-of-motion abnormality, and changes in tissue tone, texture or temperature. One of the two has to be asymmetry or range of motion.
Beyond the exam, Medicare wants a treatment plan with measurable goals, and visit notes that show the patient is still improving. When improvement stops, the care has become maintenance, and the AT modifier has to come off.
What we do: before a Medicare claim goes out, we check the note against the checklist below. If an element is missing, we hold the claim and tell you the same day, rather than send a claim the note will not support.
These are the codes that decide most chiropractic claims, and what payers look for on each one. The rules below come from Medicare and the National Correct Coding Initiative; many commercial plans apply the same edits, and we check each plan’s own policy where it differs.
| Code | What it covers | What payers look for |
|---|---|---|
| 98940 | Spinal manipulation (CMT), 1 to 2 regions | The regions billed match the regions documented.MedicareAT modifier while care is active. |
| 98941 | Spinal manipulation (CMT), 3 to 4 regions | Three or four regions documented on that date of service, each with its own finding. The level billed follows the note, not the routine. |
| 98942 | Spinal manipulation (CMT), 5 regions | All five spinal regions documented and treated: cervical, thoracic, lumbar, sacral and pelvic. |
| 98943 | Extraspinal manipulation, 1 or more regions | Commercial coverage varies, so we verify it before the visit.MedicareNot covered. |
| 97140 | Manual therapy techniques, each 15 minutes | Not payable with CMT in the same region. Billed with 59 or XS only for a separate region, documented as such. |
| 97112 | Neuromuscular re-education, each 15 minutes | The same same-region bundling rule as 97140, with the minutes and the region in the note. |
| 97110 | Therapeutic exercise, each 15 minutes | A timed code, so the minutes are documented.MedicareNot a benefit when a chiropractor provides it. |
| 97012 | Mechanical traction | Commercial plans only, when a chiropractor provides it. The note names the region and the reason. |
| 97014G0283 | Electrical stimulation, unattended | Some payers want G0283 in place of 97014. See our CPT 97014 billing guide. |
| 97035 | Ultrasound, each 15 minutes | A timed code. Commercial plans only, when a chiropractor provides it. |
| 99202 to 99215 | Office visits (E/M), new and established patients | A same-day exam with an adjustment needs a separate, significant reason and modifier 25.MedicareNot a benefit from a chiropractor. |
| 720407207072100 | Spinal X-rays: cervical, thoracic, lumbosacral | Commercial rules vary by plan.MedicareNot paid when a chiropractor takes or orders them. |
Medicare CMT (98940 to 98942) while care is corrective. Never on maintenance care.
Medicare is expected to deny the visit, for example maintenance care, and the patient signed an ABN beforehand.
Medicare is expected to deny the visit and no ABN was signed, so the practice, not the patient, absorbs it.
Services Medicare never covers from a chiropractor, such as exams, X-rays and therapies, when a secondary plan needs Medicare's denial first.
A significant, separately documented exam on the same day as an adjustment, such as a new injury or a re-evaluation. Modifier 25 explained
A therapy performed on a different region from the one adjusted. XS where the payer accepts X modifiers. Our modifier 59 guide
Sources: Medicare Claims Processing Manual, chapter 12, section 220; Medicare NCCI Policy Manual, chapter XI. CPT is a registered trademark of the American Medical Association; the descriptions above are summaries. Reviewed October 2026.
It is not for every practice. If you run a cash-only practice with no Medicare patients, you need a clean superbill process, not a billing service. And if your in-house biller keeps denials low and receivables current, keep them, and consider a periodic billing audit instead.
We look at your clean-claim rate, your denials by payer and reason, Medicare visits sent without AT, visits billed past a plan's limit and your aging PI balances, and tell you what we find, whether or not you go further with us.
We get access to your practice management system and clearinghouse, load your payer rules and fee schedules, list your open PI cases and liens, and agree how escalations work. Most practices are live within one to two weeks.
Visits are coded and claims submitted within 24 hours. Rejections are corrected the same day, remittances posted as they arrive, visit counts kept current, denials worked to their cause and PI balances followed on a schedule, all inside your system.
A report you can read in ten minutes: what was billed and collected by payer type, what was denied and why, which patients are close to their visit limit, and how old your PI and lien balances are.
You do not change systems to work with Summit Billing Solutions. We work in the practice management and EHR systems below, and through the clearinghouse you already use. If your chiropractic software is not shown, ask; the list grows as we onboard practices.
2%
Average claim rejection rate
24 hrs
Claims submitted within
28
Average days in A/R
Our practice has been billing in-house for decades. It was time for a change and a leap of faith. I couldn't be happier or more impressed with Summit and their team.
I had no idea what all the codes/terms and billing items were. It's like a foreign language but they are clear, fast, organized and patient when we had questions.
Most billing companies charge a percentage of what they collect; some charge a flat monthly fee or a per-claim rate. For a chiropractic practice, a percentage usually fits best: the company is paid when you are paid, so the incentive sits where it belongs.
Summit Billing Solutions charges between 3% and 9% of monthly collections. What moves the number for a chiropractic practice is visit volume, the share of Medicare and personal injury cases, and how clean the receivables are when we take them on, which is why we quote your exact rate after the free account review, not before.
3% to 9%
of monthly collections
We bill for more than 40 specialties, for practices in all 50 states, from Salem, New Hampshire. Each one has its own codes, modifiers and payer rules.
A free account review looks at your clean-claim rate, your Medicare denials, visits billed past a plan’s limit and your aging personal injury balances, and tells you what we would change. No cost, no obligation, and no pressure to continue. What the review covers, step by step, is on the free account review page.
50A Northwestern Drive, Salem, NH 03079
603-207-3172
(866) 906-3116
info@summitbillingsolutions.com
Mon - Fri @ 9am - 5pm
Been in private practice for over 26 years. Been through 6 billers. Some ok. Some incompetent. Some even dishonest. They don't even come close to the service from Summit.