Chiropractic Billing Services for Chiropractors and Spine Clinics

Chiropractic billing services must separate covered spinal adjustments from maintenance care, exams, and add-on treatments for every payer. Pyramids Global helps chiropractic offices file claims that match visit notes.

CONSULT OUR TEAM ON CHIROPRACTIC BILLING

Chiropractic Billing Services Tied to
Each Plan of Care

Chiropractic billing services succeed or fail on documentation that proves a patient is still improving. A typical day may include a new low back patient, a Medicare patient in week four of active care, an auto accident case, and a long-time patient on wellness visits, and each one is billed under different rules. Spinal regions treated, functional goals, and progress notes all shape what a payer will cover. Our certified coders study each treatment plan and daily SOAP note, so claims show the medical need behind every adjustment.

Chiropractor adjusting a patient’s lower back on a treatment table

What Medicare and Commercial Payers Expect
From Chiropractic Claims

Doctor of chiropractic checking a patient’s neck range of motion during an exam

Medicare covers only manual manipulation of the spine to correct a subluxation, billed with 98940 for one or two regions, 98941 for three or four, and 98942 for five. Active, corrective care must carry the AT modifier, while maintenance care is not covered and uses GA when an Advance Beneficiary Notice is signed, or GZ when it is not. The subluxation is coded first with an M99.0 segmental dysfunction code, followed by the related condition. Notes must show at least two PART findings, one of them asymmetry or range of motion change, and Medicare claims must report the date the current course of treatment began. Extraspinal manipulation (98943) and exams by chiropractors are not covered by Medicare.

Billing specialist reviewing spinal adjustment claims on a computer

Where Chiropractic Offices Lose Revenue
and the Fix for Each Problem

Chiropractic care runs on frequent, short visits, so one missing modifier or weak note can repeat across dozens of claims in a single month. Four problem areas show up again and again in chiropractic denials:

AT Modifier and Maintenance Care

Medicare pays for adjustments only while care is active and corrective. When a patient reaches maximum improvement, care becomes maintenance, and claims need GA with a signed ABN or GZ without one. Our coders read the treatment plan and latest re-exam before applying AT, GA, or GZ to any claim.

Weak PART Documentation

Daily notes must show pain, asymmetry, range of motion change, or tissue findings at the treated regions, tied to measurable functional goals. Copy-forward notes that repeat the same findings visit after visit often fail medical review. We check each note for the elements payers expect before the claim leaves.

Same-Day Services and Bundling

Adjustments include a brief pre-manipulation check, so a same-day E/M visit needs modifier 25 and its own documentation. Manual therapy on the same region is bundled unless a separate body area is treated. We review each visit’s notes before any modifier is added.

Auto and Workers’ Comp Claims

Personal injury and workers’ compensation cases follow state rules, claim numbers, adjuster approvals, and separate fee schedules. When these claims are mixed with health insurance billing, payments stall. Our team tracks each case under its correct payer and filing deadline.

Our Chiropractic Claim Workflow,
From First Visit to Discharge

Each patient is followed from the first call and coverage review through the initial exam, active care, re-exams, discharge or maintenance, claim release, insurer replies, and the final balance.

Adjustment, Exam, and Modifier Coding

Our coders match CMT codes to the number of spinal regions treated, sequence subluxation and condition codes correctly, apply AT, GA, GZ, 25, or 59 only where documentation supports them, and code exams and therapy by each payer’s rules.

Visit Limits and Chiropractic Benefit Checks

Before care begins, we verify chiropractic benefits, annual visit limits, copays, and any required approvals, then track visits used, so patients learn where their coverage stands well before the limit is reached.

Denials, Records Requests, and Appeals

If an adjustment claim comes back unpaid or a records request arrives, we pull the plan of care and visit notes, fix the claim, and send a corrected claim or appeal. Recurring payer issues are listed for your clinic every month.

Chiropractors Focused on Treatment

Chiropractors see many patients each day and spend their time adjusting, assessing, and teaching home care. Once claims and insurer calls move off the front desk, your doctors and staff can stay with patients.

Why Chiropractors and Spine Clinics Work With Our Coders

Since 2013, Pyramids Global has supported more than 500 practices across 20+ specialties. Solo chiropractors, multi-doctor clinics, and integrated spine practices value these parts of our chiropractic billing services:

Coders Trained in Chiropractic Rules

CMT codes, Medicare subluxation rules, AT and ABN modifiers, and commercial chiropractic policies are the daily focus of the certified coders assigned to chiropractic clinics.

An Assigned Clinic Billing Lead

A named billing lead gets to know your doctors, locations, and insurers, so the front desk has a familiar person for claim, visit limit, and injury case questions.

Separate Tracking for Injury Cases

Auto injury, workers’ compensation, and health insurance claims are tracked separately, each with its own deadlines, claim numbers, and adjuster details, so payments are not lost between payers.

Reports by Doctor and Payer

Each month, owners see collections, top rejection reasons, unpaid balances, and visit counts by doctor and payer type, which helps with scheduling, staffing, and payer reviews.

Average Results Across Client Accounts

Across our client accounts, we average 98% coding accuracy, 99% first-pass claim acceptance, and 86% of collections within 30 days.

How We Check Every Adjustment Claim

Chiropractic records include treatment plans, daily notes, re-exams, and outcome measures that change as patients improve. Before claims are filed, our coders confirm CMT levels, modifiers, diagnosis order, and visit counts on every chiropractic visit, so one documentation gap is less likely to repeat across a full plan of care.

Chiropractors who work with our chiropractic billing services receive clear notes on every coding decision, a monthly view of payer behavior and visit use, and records prepared for audits or insurer records requests. Billing stays steady across active care, maintenance visits, auto injury and workers’ compensation cases, and new patient exams.

Pyramids Global analysts reviewing spinal adjustment claim data

Chiropractic Billing Services Plus Front-to-Back Support

A chiropractic clinic’s income also depends on clean coding, quick plan approvals, and up-to-date payer contracts, and the American Chiropractic Association shares coding and documentation guidance that helps doctors of chiropractic record care. Alongside chiropractic billing, our team offers:

- Certified Medical Coding for spinal adjustments, chiropractic exams, and manual therapy visits.

- Prior authorization services for chiropractic care plans, typically initiated within 30 minutes of receiving the order.

- Credentialing services for chiropractors across Medicare, Medicaid, and commercial insurers in 21 states.

- Premium Practice Audit services that review modifiers, PART notes, and visit limits.

Chiropractic Billing Services:
Straight Answers for Chiropractors

How is the fee for chiropractic billing services worked out?

The fee is based on your monthly visit count, your patients’ insurance coverage, and which services you want. No setup charge is added, and our staff explains every detail during a free consultation.

Which chiropractic visits, exams, and claim types do you handle?

We bill spinal and extraspinal adjustments, new and established patient exams, re-exams, and therapeutic procedures. We also handle personal injury, workers’ compensation, Medicare, Medicaid, and commercial claims, along with patient statements.

When does Medicare require the AT modifier on chiropractic claims?

The AT modifier is required when spinal manipulation is active or corrective treatment that is expected to improve function. Once care becomes maintenance, Medicare does not pay, and the claim uses GA with a signed ABN or GZ without one.

What is the timeline for chiropractic care plan approvals?

Requests are typically initiated within 30 minutes of receiving the order. Payers usually decide urgent requests in 24 to 72 hours, while standard reviews often take 7 to 14 business days.

Can we keep our current chiropractic EHR?

Yes, our team works inside the EHR or chiropractic software your clinic uses today. A Business Associate Agreement is in place with each chiropractic client, and patient information is protected under HIPAA standards.

How will our clinic track results each month?

A monthly report shows collections, rejection reasons, unpaid balances, and visit counts for each doctor and payer type, so trends are easy to follow.

Schedule a Free Chiropractic Billing Consultation Today

Chiropractic clinic owner going over claim reports with an advisor

Missing AT modifiers, maintenance care billed as active, or stalled injury claims point to gaps in chiropractic billing. Since 2013, Pyramids Global has supported more than 500 practices across 20+ specialties, and a free consultation is the first step to see where your chiropractic claims stand.

Our team can manage adjustment and exam coding, coverage checks, visit limit tracking, injury case billing, payment posting, denial follow-up, and patient statements. This gives your chiropractors and front office more time for adjustments, patient education, home care instruction, and recovery plans.

CONSULT US FOR A CHIROPRACTIC BILLING REVIEW