Let’s be real, keeping up with chiropractic billing changes can feel like adjusting your spine: necessary, but not exactly fun. As we dive into 2025, chiropractors are facing a fresh wave of billing updates, stricter documentation guidelines, evolving CPT codes, and increasingly picky insurance payers.
But don’t worry. We’ve got your back.
Staying compliant isn’t just about ticking boxes. It’s about protecting your revenue and making sure you get paid for the care you provide. Recent data shows that claim denial rates across outpatient services, including chiropractic, rose by 11.5% in 2024 alone (RevCycleIntelligence, 2024). That’s time, money, and energy down the drain if your billing isn’t airtight.
What is Chiropractic Billing and Coding?
Translating the chiropractic services, like spinal adjustment or therapy sessions, into standardized medical codes and submitting them to the insurance company is called Chiropractic medical billing and coding. This process ensures the healthcare provider gets reimbursed for the services provided to the patient.
Chiropractic Billing Process
1. Patient Intake
Collect the patient’s demographic and insurance information. This step is crucial for entering accurate data into the billing system and preventing errors down the line.
2. Verify Benefits (VOB)
Check the patient’s insurance coverage, including:
- Deductibles
- Copays
- Visit limits
- Pre-authorization requirements
Verifying benefits upfront helps avoid claim denials and informs patients of their financial responsibility.
3. Document Services
Use detailed SOAP (Subjective, Objective, Assessment, Plan) notes to record the patient visit. Proper documentation supports medical necessity and serves as the foundation for accurate coding.
4. Assign Codes
Assign the correct billing codes, including:
- CPT codes for procedures performed
- ICD-10 codes for diagnoses
- Modifiers to clarify or adjust how a service was rendered
Accurate coding ensures correct reimbursement from insurers.
5. Submit Claim
Create and submit the claim through medical billing software or a clearinghouse. Claims should be reviewed for accuracy before submission to reduce the risk of rejections.
6. Track Status
Monitor submitted claims regularly to identify any rejections or delays. Follow up promptly with payers to resolve issues and keep cash flow steady.
7. Post Payment
After the insurer processes the claim, record the payment and apply it to the patient’s account. Any remaining balance should be billed to the patient.
8. Appeals
If a claim is denied, gather the necessary documentation and submit an appeal. This process is essential for recovering rightful payments and correcting payer errors.
9. Patient Billing
Send clear and timely statements to patients for their share of costs. Include details of the services, insurance payments, and options for settling balances.
Core Components of Chiropractic Billing
Your foundation for faster payments and fewer denials.
Chiropractic Medical billing is more than just code entry; it’s a precision-driven process that directly impacts your cash flow. To avoid denials and delays, every step must be done right, from coding to claim submission. Let’s break down the essentials:
Chiropractic CPT Codes
| CPT Code | Description |
| 98940 | Spinal manipulation, 1–2 regions |
| 98941 | Spinal manipulation, 3–4 regions |
| 98942 | Spinal manipulation, 5 regions |
Common Modifiers in Chiropractic Billing
| Modifier | Meaning | When to Use |
| AT | Active Treatment | Required for Medicare claims to show medical necessity (not maintenance care). |
| GA | Waiver of liability statement on file | Use when an ABN (Advance Beneficiary Notice) is issued to the patient. |
| GZ | Item or service expected to be denied, no ABN on file | Use when you didn’t issue an ABN, but believe the service won’t be covered. |
Documentation is Everything
In 2025, insurance companies are scrutinizing chiropractic documentation more closely than ever. Gone are the days of vague notes and generalized treatment plans. To get paid and stay compliant, you need to justify each visit and demonstrate the medical necessity of care.
Every progress note should answer three core questions:
- What’s the patient’s condition or diagnosis?
- What specific treatment was given and why?
- Is there measurable improvement over time?
Verification of Benefits (VOB)
Before a patient even lies on the table, it’s critical to verify their insurance benefits. This isn’t just a formality, it’s your first line of defense against unpaid claims. Chiropractic coverage varies widely across plans and payers, and assuming a service is covered can be a costly mistake.
A thorough VOB should include:
- Check if chiropractic care is included in their plan.
- Confirm how many visits are allowed.
- Determine if pre-authorization or referrals are needed.
Verification of Benefits (VOB) Checklist
Use this before the patient receives care:
- Is chiropractic care a covered benefit under this plan?
- How many visits are allowed per year or benefit period?
- Are there any visit caps per diagnosis?
- Is prior authorization required for initial or extended care?
- Are referrals needed (e.g., from PCP)?
- Are imaging services (X-ray, MRI) covered?
- What are the patient’s copay, coinsurance, and deductible?
- Is the provider in-network or out-of-network?
- Are there any restrictions on modifiers or CPT codes?
Timely Filing
Every insurance payer sets a strict window for when claims must be submitted, usually within 90 to 180 days from the date of service. This timeline may vary depending on the specific insurance plan or contract, so keeping track of each payer’s rules is crucial.
Ensure Compliance with Audit Readiness
Chiropractic practices are increasingly being targeted for payer audits, especially by Medicare, due to high denial rates and documentation issues. In 2025, compliance isn’t just about following rules, it’s about being ready to prove that your care was necessary, covered, and properly billed.
Here’s what audit-ready compliance looks like:
- Complete SOAP Notes: Every visit must include subjective complaints, objective findings, an assessment, and a clear plan.
- Medical Necessity Proof: Regularly update progress notes to show measurable improvement or adjustments in care plans.
- Proper Use of Modifiers: Especially for Medicare, ensure modifiers like AT, GA, or GZ are accurately used and justified in the documentation.
- ABNs on File: If there’s even a chance a service won’t be covered, have signed Advance Beneficiary Notices (ABNs) documented and retrievable.
What are the challenges in chiropractic billing and coding?
Understanding and addressing these challenges is key to maintaining a smooth revenue cycle and avoiding costly mistakes.
Incorrect CPT and ICD-10 Coding
Mistakes in coding, like using the wrong CPT codes or modifiers, often result in claim denials or reduced reimbursements.
Medical Necessity Documentation
Lack of detailed documentation proving medical necessity is a common cause of claim rejections, especially with Medicare.
Timely Filing Deadlines
Missing submission deadlines (90–180 days) leads to lost payments, as claims can’t be refiled or appealed after the cut-off.
Insurance Pre-Authorization
Failure to obtain necessary pre-authorizations for extended care or imaging leads to claim denials and out-of-pocket costs for patients.
Inconsistent Patient Benefits Verification
Not verifying patient benefits upfront leads to unexpected out-of-pocket costs, confusion, and delayed payments due to uncovered services.
Frequent Claim Denials and Appeals
Chiropractors often face claim denials, requiring time-consuming appeals processes and resulting in delayed revenue.
Strategies that can help you improve billing for chiropractic medicine
Managing Chiropractic Medical Billing doesn’t have to feel overwhelming. Below are smart, actionable strategies that are designed for chiropractic practices to reduce denials and maximize reimbursements
Build a Knowledge-Driven Billing Team
The best way to avoid costly mistakes is by ensuring your billing staff is equipped with up-to-date knowledge. Offer continuous training on chiropractic-specific coding, modifier usage, and payer policies, especially Medicare requirements. A well-trained team is your first line of defense against errors and denials.
Implement Chiropractic-Focused Billing Software
Generic billing platforms often lack the specificity needed for chiropractic services. Adopt software tailored to chiropractic care that includes pre-set templates for common CPT codes, spinal regions, and modifier use. This ensures accuracy, saves time, and streamlines claim submissions.
Standardize Clinical Documentation
Develop structured documentation templates for patient visits that capture key details such as diagnosis, treatment area, techniques used, and patient progress. Consistent and comprehensive documentation supports medical necessity and strengthens claim validity.
Automate Key Billing Workflows
Utilize automation features in your billing system to handle tasks like eligibility checks, claim generation, and submission tracking. Automation minimizes manual errors, ensures timely filing, and frees up staff to focus on more complex billing or patient coordination tasks.
Conduct Regular Internal Audits
Schedule routine audits of your billing and documentation processes to identify and correct recurring errors. This helps prevent claim denials, reduces compliance risks, and ensures your practice is prepared for external payer reviews or audits.
Verify Insurance Coverage Before Treatment
Always verify each patient’s benefits before care begins. Confirm chiropractic coverage, visit limitations, and whether prior authorization or referrals are needed. This step helps avoid providing services that may not be reimbursed.
Advantages of Outsourcing Chiropractic Medical Billing
Outsourcing chiropractic medical billing is a smart move billing experts take the burden off your shoulders while improving reimbursement rates and ensuring full compliance with payer requirements.
Reduced Administrative Burden
Outsourcing frees up your front desk and in-house staff from time-consuming billing tasks like claim submission, follow-ups, and appeals so they can focus more on patient care and office operations. Chiropractors spend up to 20% of their time on administrative tasks, including billing (American Chiropractic Association).
Fewer Errors and Faster Payments
Experienced billing professionals understand payer rules, coding updates, and documentation requirements, which reduces claim errors and rejections, speeding up reimbursement timelines. Industry data shows that claim error rates drop by 60% when billing is handled by experienced third-party services (MGMA).
Improved Revenue Cycle Management
Outsourced teams track denials, file appeals promptly, and optimize coding strategies to help maximize collections and reduce outstanding AR.
Cost Savings
Eliminates the need for in-house billing software, training, and staff salaries. You pay only for the services you need often less than maintaining a full-time team.
Scalability and Flexibility
Whether you’re expanding your practice or navigating seasonal patient flow, outsourcing allows you to scale billing services without hiring more staff.
Compliance with Industry Regulations
Billing companies stay updated on Medicare guidelines, HIPAA, and payer policies ensuring that your practice remains compliant and audit-ready.
Final Thought
Chiropractic billing can be complex, but staying updated with proper coding, documentation, and verification is key to faster reimbursements and fewer denials. By optimizing billing practices, you can ensure smoother operations and better cash flow for your practice.
Why Makes Cloudrcm The Best Choice?
Tired of billing errors and delays? Outsource your chiropractic medical billing to CloudRCM. Our expert team ensures timely payments, fewer denials, and full compliance, so you can focus on patient care and grow your practice. Contact us today to improve your billing process!
Reach out today at: (224) 231-6880 to improve your billing process.
FAQs
What is chiropractic medical billing and coding?
Chiropractic medical billing and coding involves converting chiropractic services into standardized codes (CPT and ICD-10) for insurance reimbursement. This process ensures chiropractors are paid for the care they provide.
Why is documentation important in chiropractic billing?
Proper documentation is crucial to demonstrate medical necessity and justify the services provided. Insurance companies require clear and accurate records to approve claims and ensure timely reimbursement.
What is timely filing in chiropractic billing?
Timely filing refers to submitting insurance claims within a specific period, typically 90 to 180 days from the date of service, to avoid denials due to late submission.
