Chiropractic billing looks simple on the surface, you treat a patient, you submit a claim but the reality is nuanced. Medicare and many commercial payers limit coverage (manual spinal manipulation is a limited Medicare benefit), CPT code rules and modifiers (for example, the AT modifier and the set of CMT codes) require precise documentation, and a single miscoded or undocumented visit can turn into a denial or write-off. Clear coding (98940 – 98942 for spinal CMT; 98943 is extraspinal and may not be covered by Medicare), appropriate use of modifiers, and tightly managed claim follow-up are the difference between on-time payment and long accounts receivable.
Common CPT codes used by Chiropractors
CPT Code
What it is
Notes
98940
CMT — spinal, 1–2 regions
Most commonly billed. Document regions.
98941
CMT — spinal, 3–4 regions
Use only when documentation supports 3–4 regions.
98942
CMT — spinal, 5 regions
Less common; use only with supporting documentation.
98943
CMT — extraspinal
Not a Medicare benefit (may be covered by some private insurers).
97110 / 97112 / 97140
Therapeutic exercises / NM re-ed / manual therapy
Billed when clinically distinct from CMT.
The core components of chiropractic billing
- Insurance verification & eligibility — Verifying benefits up front prevents surprises and underpayments.
- Claims submission & clearinghouse management — Clean claims get paid faster; specialized clearinghouse setup for chiropractic CPT/HCPCS helps.
- Denial management & appeals — Successful appeals and denial prevention boost net collections.
- Patient statements & collections — Patient balances are rising industry-wide; clear statements and payment plans are essential.
Common billing pitfalls
- Pitfall: Wrong modifier usage (or missing AT modifier for Medicare).Fix: Create a modifier checklist in the EHR front desk workflow.
In-House vs. Outsourced Billing | Comparison
Feature
In-House Billing
Outsourced Billing (generic)
revaxismd (recommended)
Staffing costs
High (salaries + training)
Lower (pay per collection or flat fee)
Competitive pricing + specialist chiropractic RCM team (no training lag)
Expertise in chiropractic CPT/modifiers
Varies
Specialist vendors often better
Dedicated chiropractic coders and denial experts — reduces denials
Denial/appeal performance
Often reactive
Proactive appeal workflows
Proactive denials management, appeals, and AR follow-up tailored to chiro rules
Technology & reporting
Dependent on practice EHR
Often includes advanced dashboards
Integrated dashboards + KPI reports (collections, DNFC, AR days)
Scalability
Limited by staff
Easy to scale
Scales with practice growth; flat % or hybrid pricing options
Compliance & security
Practice must manage
Vendor handles (should be HIPAA compliant)
HIPAA compliant, secure handling & regular audits
How revaxismd Helps Chiropractic Practices
revaxismd specialize in RCM for small-to-medium healthcare practices, including chiropractors. Here’s how we deliver measurable results:
- Chiropractic-specialist coding team: Coders trained in CMT (98940–98942), E/M integration, and modifier rules to cut down front-end denials.
- Eligibility & benefits verification: We verify patient benefits before visit and document payer rules (including PT/OT/E&M overlaps) to reduce rejections.
- Clean claim submission: Claims scrubbed against top payer edits and submitted through high-throughput clearinghouses for faster adjudication.
- Transparent reporting: Weekly KPI dashboards (collections, AR days, denial reason breakdown) so you can see progress.
- Seamless EHR integration: We work with common chiropractic EHRs and practice systems (ChiroTouch, DrChrono, Genesis, Kareo, etc.) to keep workflows smooth.
Value proposition: We handle the billing so providers can focus on patient care with pricing that aligns to your collections and a fast onboarding process.
revaxismd can run a free 30-point billing audit on a sample of your recent claims (no charge) to show where revenue is being lost and how much we can recover.Email us or schedule a demo to see our chiropractic-specific KPI dashboard.
Schedule a Consultation
Schedule your consultation today and start your journey towards a healthier Revenue Cycle Management. Contact us now!
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