Medical practices & clinics · 25 October 2026

Chiropractic Insurance Billing Basics: Codes, Modifiers and Medicare Rules

A plain-English guide to codes, modifiers, documentation and payer rules for chiropractic practices

Chiropractic billing looks simple from the outside: most visits involve an adjustment and perhaps some therapy or an exam. In practice it is one of the more rule-heavy areas of outpatient billing. Medicare covers only a narrow set of chiropractic services, commercial plans often cap visits or require authorization, and auto and workers' compensation claims follow their own rules entirely. This guide covers the basics every chiropractic office should get right.

This is general information, not legal or coding advice. Payer policies change, so always check the current policy for each payer you bill.

The core codes: chiropractic manipulative treatment (CMT)

Spinal adjustments are billed with the CMT codes, chosen by the number of spinal regions treated:

98940: spinal CMT, 1–2 regions
98941: spinal CMT, 3–4 regions
98942: spinal CMT, 5 regions
98943: extraspinal CMT, one or more regions (for example, extremities)

The five spinal regions for CMT are cervical, thoracic, lumbar, sacral and pelvic. The regions billed must match the regions documented as treated, and the diagnoses on the claim should support treatment of each of those regions. Billing 98941 when the note only describes two regions is a common audit finding.

Exams and evaluation and management (E/M) on the same day

CMT codes include a brief pre-manipulation assessment. A separate E/M service on the same day as an adjustment (for example, a new patient exam, a re-exam, or evaluation of a new complaint) can be billed when it is significant and separately identifiable, usually with modifier 25 on the E/M code. Routine daily checks before an adjustment generally don't qualify. Overusing modifier 25 is a frequent reason for payer reviews.

Therapy and modalities alongside adjustments

Many chiropractic visits include therapeutic procedures or modalities, such as:

97110 therapeutic exercise
97112 neuromuscular re-education
97140 manual therapy techniques
97530 therapeutic activities
97014 / G0283 unattended electrical stimulation (G0283 is used by Medicare and some other payers)

Timed codes like 97110 and 97140 are billed in 15-minute units, and the note must record the time spent. Payers usually expect a plan of care that explains why the therapy is needed.

97140 with CMT deserves special attention. National Correct Coding Initiative (NCCI) edits bundle manual therapy with CMT when they are performed on the same region. If manual therapy was performed on a separate anatomic region, payers may allow it with a modifier such as 59 or XS, but only when the documentation clearly shows the different region. Using the modifier without that documentation is a common denial and audit risk.

Remember that Medicare does not pay doctors of chiropractic for therapy services or exams. Those services can still be billed to Medicare for a denial if the patient needs a denial to submit to secondary insurance, but they won't be paid by Medicare.

Medicare chiropractic rules

Medicare Part B covers only manual manipulation of the spine to correct a subluxation. That means only 98940, 98941 and 98942 are covered when billed by a chiropractor. Key points:

Active treatment and modifier AT. Medicare covers CMT when it is active or corrective treatment expected to improve the patient's condition. Claims for active treatment should carry the AT modifier.
Maintenance care. Treatment that is maintenance rather than corrective is not covered. If you expect Medicare to deny a service as not medically necessary, give the patient an Advance Beneficiary Notice (ABN) before the service and use the GA modifier. Services that Medicare never covers when furnished by a chiropractor (such as extraspinal adjustments, exams or therapy) are billed with the GY modifier when you need a denial. GZ is used when you expect a medical-necessity denial but no ABN was given. Check current Medicare guidance before relying on any of these.
Documenting subluxation. Medicare allows subluxation to be shown by x-ray or by physical exam. For physical exam, Medicare's "PART" criteria apply: Pain/tenderness, Asymmetry/misalignment, Range of motion abnormality, and Tissue/tone changes. Two of the four are required, and one of them must be asymmetry or range of motion.
Initial treatment date. Medicare claims for CMT need the date treatment was initiated and, if used, the x-ray date.
Diagnosis order. Medicare generally expects the subluxation code for the region treated as the primary diagnosis, with the related condition listed as secondary. Your Medicare Administrative Contractor (MAC) publishes a local coverage policy for chiropractic services that explains its diagnosis requirements.

Commercial plans

Commercial plans vary widely. Before the first visit, and when the plan year resets, verify:

Whether chiropractic is covered and the visit limit per year
Whether therapy and modality visits count toward the same limit
Copay, coinsurance and deductible
Whether prior authorization or a referral is required
Whether the plan uses a separate network manager for chiropractic or physical medicine

Some plans manage chiropractic benefits through a third-party administrator that requires its own registration and visit approvals. Missing those approvals leads to denials that are hard to overturn.

Auto, personal injury and workers' compensation

Auto insurance (including personal injury protection in states that have it) and workers' compensation are billed differently from health insurance. They often require a claim number, an adjuster's details, state-specific forms and periodic reports. Fee schedules are set by state rules or the carrier. Keep these cases separate in your PM system so they aren't accidentally billed to the patient's health plan.

Documentation habits that prevent denials

Record the regions treated and the technique used for every adjustment.
Record time in minutes for every timed therapy code.
Keep the treatment plan current, with measurable goals and re-exam dates.
Note functional progress, not just pain scores, to support active treatment.
Keep ABNs on file and signed before the service, not after.

A quick pre-submission checklist

Is the patient's coverage active and are visits remaining?
Do the CMT regions billed match the note and the diagnoses?
Is modifier AT on Medicare active-treatment claims?
Is 97140 on a different region from the adjustment, and documented as such?
Are E/M services truly separate and supported before using modifier 25?
Are timed units supported by documented minutes?

Where denials usually come from

Most chiropractic denials trace back to a handful of causes: eligibility and visit limits, missing authorizations, CMT regions that don't match the documentation, bundling edits on 97140, and Medicare maintenance-care decisions. Each of these can be caught before the claim goes out, and many denied claims can still be corrected and resubmitted or appealed if someone works them before the payer's deadline. Our article on behavioral health denial management describes a denial workflow that applies just as well to chiropractic claims.

Next step

MedBill Solutions provides insurance billing for independent practices, including chiropractic offices: claims submission, claim tracking, denial and payer follow-up, payment posting and monthly reports, inside the system you already use. See our billing services for medical practices, or if you have a backlog of unpaid claims, our old claims service works them for 3% of what we recover, with no fee if nothing is recovered.

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