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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