Chiropractic
Healthcare IT and billing built for a chiropractic practice
Medicare AT modifier rules, treatment plan documentation and cash-plan management for chiropractic practices.
Why chiropractic is different
Chiropractic is among the most audited services in Medicare, where coverage requires active treatment documentation, an AT modifier, and a clear distinction between corrective care and maintenance therapy.
Healthcare SBC builds that standard into every encounter: subluxation documentation, treatment plans with measurable goals, visit counting against plan limits, while supporting the cash and membership plans most practices also run.
Common challenges
Where chiropractic practices lose revenue
The billing and workflow problems specific to this specialty, and the ones generic systems handle badly.
Active treatment versus maintenance
Medicare covers only active corrective treatment; maintenance care must be identified and billed to the patient.
AT modifier compliance
Claims require the AT modifier with documentation demonstrating active treatment, or they are denied and audited.
Region-based manipulation coding
CMT codes are defined by spinal regions treated, requiring precise documentation.
Cash and membership plans
Prepaid packages and memberships need tracking outside standard insurance billing.
How we address it
Built for chiropractic workflows
- Subluxation and region documentation driving correct CMT code selection
- Automated AT modifier logic tied to active treatment documentation
- Treatment plans with measurable goals and visit tracking
- Cash plan, package and membership management with visit decrementing
- Outcome assessment tools integrated into the visit workflow
Commonly billed codes in chiropractic
A sample of the codes our chiropractic coders work with daily.
- 98940Chiropractic manipulative treatment, 1-2 regions
- 98941Chiropractic manipulative treatment, 3-4 regions
- 98942Chiropractic manipulative treatment, 5 regions
- 97110Therapeutic exercise, each 15 minutes
- 97140Manual therapy techniques, each 15 minutes
Codes shown for reference only. Verify against current code sets and payer policy.
FAQ
Chiropractic, frequently asked questions questions
- What does Medicare require for chiropractic claims?
- Medicare covers manual manipulation of the spine to correct a subluxation when there is active treatment expected to improve the condition. Claims require the AT modifier and documentation of the subluxation, the treatment plan and measurable progress. Maintenance care is not covered and must be billed to the patient.
- How do you document active treatment?
- Treatment plans capture measurable functional goals and objective progress at defined intervals, producing exactly the documentation Medicare reviewers request, and flagging when a patient has transitioned to maintenance care.
- Can you manage cash and membership plans?
- Yes. Prepaid packages, memberships and cash plans are tracked with automatic visit decrementing, expiration handling and revenue recognition alongside insurance billing.
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