Chiropractic care is increasing day by day as 50% of people only in the US visit a chiropractor in their lives and due to the high demand for this care, chiropractors need to provide more than just patient care. Revenue cycle management is also a crucial component of chiropractic practices. Each provider wants higher reimbursement for the services they rendered and insurance billing plays a major role here. Accuracy of claims matters in insurance billing as detailed and accurate claims get higher and quick reimbursement. Medical billing is not just running a chiropractic practice but it’s about getting paid on time and avoiding dreaded claim denials. So let’s talk about what thing you need to know to keep your billing smooth and stress-free.
Why Chiropractic Billing Matters?
Chiropractic care is different from other care especially when talking about insurance coverage. While most insurance plans cover chiropractic services to some extent, the coverage details, limitations, and documentation requirements can change greatly. That’s why understanding the right CPT or Current Procedural Terminology codes and billing guidelines is crucial. Accurate coding is the link between insurance companies and the services you’ve provided. When the practice does not have proper billing and coding and faces some common mistakes of using wrong codes or missing required modifiers then it leads to delays, rejected claims, or underpaid for the work they’ve already done. With the proper billing and coding, healthcare practices ensure consistent cash flow and fewer headaches when dealing with insurance companies.
The Basics of CPT Codes for Chiropractic Billing
Medical billing codes are standardized codes that each practice follows to get reimbursement for the procedures and services they’ve provided. Billing with an insurance company means having a detailed report on what you did for this patient. Two types of codes are commonly used in medical billing: ICD-10 codes to define the diagnosis and CPT codes for different treatment options of chiropractic. Each code corresponds to a specific service, and it’s how insurers determine whether they’ll cover the treatment and how much they’ll reimburse you. For chiropractors, most of the core billing falls under codes related to spinal manipulation, exams, and therapeutic procedures. Let’s see some of the most commonly used codes and how to use them correctly.
Chiropractic Manipulative Treatment (CMT) Codes
CMT is the most common code of chiropractic billing. They cover spinal adjustments and manipulations which are the backbone of most chiropractic treatments. These CMT codes include:
- 98940 – Chiropractic adjustment of 1-2 spinal regions
- 98941 – Chiropractic adjustment of 3-4 spinal regions
- 98942 – Chiropractic adjustment of 5 or more spinal regions
- 98943 – Chiropractic adjustment of extra-spinal areas like the extremities—think shoulders, knees, elbows, etc.
To use these codes effectively you need to document exactly which regions you treated and why. Insurance companies want to see that the treatment is medically necessary so make sure your notes back up the codes you’re using.
Evaluation and Management (E/M) Codes
E/M codes are used to diagnose, create treatment plans, and monitor patient progress. The commonly used E/M codes include:
- 99202 – New patient, straightforward case
- 99203 – New patient, low complexity
- 99204 – New patient, moderate complexity
- 99205 – New patient, high complexity
- 99212 – Established patient, straightforward case
- 99213 – Established patient, low complexity
- 99214 – Established patient, moderate complexity
- 99215 – Established patient, high complexity
The complexity level depends on factors like how many issues you’re addressing, the type of exam performed, and the level of medical decision-making involved. More complex cases include higher codes for better reimbursement but only if the documentation supports it.
If you’re using an E/M code on the same day as a CMT code, you’ll usually need to attach a modifier -25 to show that the evaluation was separately identifiable from the adjustment.
Therapeutic Procedures and Modalities
Chiropractic care includes therapies related to things like muscle work, electrical stimulation, and therapeutic exercises. These codes capture those services:
- 97110 – Therapeutic exercises (strength, flexibility, balance)
- 97112 – Neuromuscular re-education (coordination, posture)
- 97124 – Massage therapy
- 97014 – Electrical stimulation (unattended)
- 97032 – Electrical stimulation (attended)
- 97035 – Ultrasound therapy
Therapeutic codes are billed in 15-minute increments in most cases so make sure your time documentation matches up with what you’re billing.
Radiology (X-Ray) Codes
If you’re taking X-rays in-house, you’ll need to bill separately for that service. The main codes you’ll use are:
- 72020 – Single-view X-ray
- 72040 – Cervical spine, two or three views
- 72070 – Thoracic spine, two views
- 72100 – Lumbar spine, two or three views
Keep in mind that some insurers require pre-authorization for X-rays so check the patient’s benefits before snapping those pictures.
Common Modifiers in Chiropractic Billing
Modifiers are those little extra codes that clarify or adjust the meaning of the main CPT codes. They’re essential for getting your claims processed correctly. Here are the key modifiers you’ll use in chiropractic billing:
- -25 – Significant, separately identifiable E/M service (used when an exam and adjustment happen on the same day)
- -59 – Distinct procedural service (used when you perform two distinct services that might otherwise be bundled)
- -GA – Waiver of liability statement on file (used when the patient signed an ABN for a non-covered service)
- -GP – Indicates that the service was provided under a physical therapy plan of care (sometimes required for rehab codes)
Don’t overuse modifiers as insurance companies consider excessive use of modifiers as potential fraud. But when they’re necessary, they’re a lifesaver for clean claims.
Documentation: The Key to Getting Paid
Documentation is as important as coding in medical billing. You can bill all the right codes but if your documentation doesn’t back them up, you’re not getting paid. Insurance companies are looking for proof of medical necessity essentially, why the patient needed the service and how it helped them. Good documentation should cover:
- Patient’s history and chief complaint
- Exam findings and diagnosis
- Treatment plan (frequency, duration, goals)
- Why the specific adjustment or therapy was necessary
- Patient progress over time
If you’re billing for more than just a quick adjustment, your notes need to reflect the extra time and effort involved. And if you get hit with an audit, thorough notes will save you big time.
Best Practices for Smoother Chiropractic Billing
Use billing software – Automated billing software can help you remove errors, verify eligibility, submit claims, and speed up the process. Make sure it covers all the aspects that your practice needs.
Stay on top of code changes – CPT codes get updated every year so review them regularly to stay compliant and keep your chiropractic practice safe from penalties and rejections.
Train your staff – If you’ve got a billing team, make sure they understand all the complexities of chiropractic coding. The billing team must have knowledge of the rules and regulations of medical billing.
Appeal denials quickly – Don’t leave any claims. If you believe a denial was made in error then appeal it with proper documentation.
Outsource Your Chiropractic Billing Services
If chiropractic practices want more organized and improved reimbursement then outsourcing chiropractic medical billing services is also a great option. Choose the best medical billing company like M&M Claims Care which has provide chiropractic billing services for years. We help you to translate chiropractic diagnoses and treatments into codes accurately. We have an experienced team of medical billers and coders who work to increase your cash flow, better your reimbursement, and provide you peace of mind by handling all the denials and compliance. With M&M Claims Care you can handle your patients with great care and we’ll handle all your billing operations with higher accuracy.
