Billing, coding and collections for solo chiropractors, multi-location groups, and chiropractic and rehab clinics that see Medicare, commercial, auto injury and workers compensation patients.
A chiropractic visit is paid at a low rate per code, so small misses add up fast. A 2026 Medicare 98941 is allowed $38.41 at the national non-facility rate, and a claim sent without the AT modifier denies as maintenance care. Medicare found 30.4% of chiropractic payments improper in its 2025 review, mostly for thin documentation. Luxen runs full-service medical billing for chiropractic practices inside the software you already use, with a BAA signed before we touch a chart.
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Chiropractic billing services code, submit and collect on adjustments, therapy and exams for chiropractic practices, covering Medicare AT modifier rules, commercial visit limits and auto injury claims. Medicare pays only for spinal manipulation, and in our claim audit the AT modifier was missing on 13% of Medicare active treatment claims.
We bill for chiropractic practices whose payer mix changes the work on every claim.
Service lines we bill: spinal manipulation, extraspinal manipulation, therapy and rehab codes, in-office X-ray, supports and braces, workers compensation, auto injury and self-pay care plans.
Chiropractic revenue leaks through rules that repeat on every visit. Dollar figures use 2026 Medicare national non-facility rates at the $33.4009 conversion factor, before geographic adjustment and patient cost sharing.
| Scenario | Codes | What goes wrong | $ at stake per claim | Luxen audit finding |
|---|---|---|---|---|
| Medicare active care visit | 98941 with AT | AT left off, so the claim denies as maintenance therapy | $38.41 per visit | The AT modifier was missing on 13% of Medicare active treatment claims |
| Manual therapy on adjustment day | 98940 with 97140 | Therapy billed in the same spinal region, or a different region without 59 or XS | $27.72 per unit of 97140 | Manual therapy billed with an adjustment lacked modifier 59 or XS on 11% of chiropractic claims |
| Five regions billed, fewer documented | 98942 vs 98941 | Regions on the claim exceed the subluxation levels in the note | $11.36 difference per visit | Coding and modifier errors caused 21% of denials |
| Commercial plan visit limit reached | 98941 with 97110 | Visits keep billing after the annual limit, then deny | $67.47 per visit | Eligibility and coverage errors caused 24% of denials |
| Florida auto injury claim | 98941 under PIP | Care starts after 14 days, or the $2,500 non-emergency cap is reached | $76.82 per 98941 at 200% of the national rate | Timely filing caused 6% of denials, and only 4% of those were recovered |
Most chiropractic claims are built from three spinal manipulation codes, a subluxation diagnosis and a handful of therapy codes. Our certified medical coders match each line to the note before it leaves the practice.
| Code | Service | 2026 Medicare non-facility | 2026 Medicare facility | Medicare coverage when billed by a chiropractor |
|---|---|---|---|---|
| 98940 | Spinal manipulation, 1 to 2 regions | $26.72 | $18.37 | Covered with AT for active treatment |
| 98941 | Spinal manipulation, 3 to 4 regions | $38.41 | $28.06 | Covered with AT for active treatment |
| 98942 | Spinal manipulation, 5 regions | $49.77 | $38.08 | Covered with AT for active treatment |
| 98943 | Extraspinal manipulation, 1 or more regions | Status N, not covered | Status N, not covered | Not covered; check each commercial plan |
The code depends on how many spinal regions were treated and documented, not how many were adjusted out of habit. A note that names subluxations at C5 and L5 supports 98940, even if the whole spine was treated.
WPS billing article A56273 requires a segmental and somatic dysfunction code from M99.00 to M99.05 as the primary diagnosis, with the neuromusculoskeletal condition that made treatment necessary as the secondary diagnosis. The article sorts those secondary conditions into groups by how long treatment is expected to take, so the pairing affects how many visits look reasonable on review.
Medicare covers only manual manipulation of the spine to correct a subluxation. The modifier on each line tells Medicare whether the care is active, maintenance or outside the benefit.
CMS guide MLN1232664 says to use AT for active or corrective treatment of acute or chronic subluxation because Medicare requires it to pay 98940, 98941 and 98942. Contractor instructions treat a manipulation claim without AT as maintenance therapy and deny it. Once the condition is stable, further care is maintenance and is not covered.
Subluxation can be shown by X-ray or by physical exam. On exam, two of the four PART findings are required, and one must be asymmetry or range of motion:
An X-ray used to document subluxation must be taken within 12 months before or 3 months after treatment starts. The initial visit note also needs the treatment plan: visit frequency, goals, objective measures and the date treatment began.
| Situation | Modifier | ABN | Who pays |
|---|---|---|---|
| Active or corrective adjustment | AT | Not needed | Medicare, after deductible and coinsurance |
| Adjustment expected to deny as maintenance, ABN signed | GA | Required | Patient, if Medicare denies |
| Adjustment expected to deny, no valid ABN | GZ | Missing | Practice absorbs the denial |
| Exam, X-ray or therapy by the chiropractor | GY, plus GX if a voluntary notice was given | Voluntary | Patient |
Routine or blanket ABNs are usually not permitted, so the notice has to name the visits expected to deny and why.
The 2025 Medicare improper payment report put chiropractic at a 30.4% improper payment rate, with 89.5% of those errors tied to insufficient documentation. An earlier OIG audit of 2013 claims found $358.8 million, about 82% of Medicare chiropractic payments, unallowable. Chiropractors also cannot opt out of Medicare, so a Medicare patient cannot sign a private cash contract for a covered adjustment. When records requests arrive, our denial and AR recovery team answers them from the note, not from memory.
Outside Medicare, chiropractic cash flow depends on two clocks: auto injury rules and commercial visit limits. In our billing reviews, auto injury and PIP claims made up 28% of chiropractic AR past 90 days.
Under section 627.736 of the Florida Statutes:
A clinic that never requests the emergency determination from the referring provider caps its own case at $2,500. See how we handle medical billing in Florida across PIP carriers.
Many commercial plans cap chiropractic visits per year or send care through a utilization review vendor after a set number of visits. Some states limit that. Indiana Code 27-1-37.5-13.7, effective July 1, 2025, bars a utilization review entity from requiring prior authorization for the first 12 chiropractic or physical therapy visits of each new episode of care. More on Indiana medical billing rules.
We verify benefits and remaining visits before the care plan starts through our eligibility and prior authorization work, and a medical virtual assistant can keep the visit count current at the front desk.
Work injury claims run on a state fee schedule and an employer claim number, not the patient's health plan. Lien and letter of protection cases need a signed agreement, regular statements to the attorney and a follow-up date tied to the case, or the balance ages without anyone noticing.
The rule: Medicare requires AT to pay 98940 to 98942, and contractors deny manipulation claims without it as maintenance therapy (CMS MLN1232664). The cost: $38.41 for every 98941 visit. In our claim audit, the AT modifier was missing on 13% of Medicare active treatment claims.
The rule: a PART exam with two of four findings, one of them asymmetry or range of motion, is enough. An X-ray is optional, and when used it must fall within 12 months before or 3 months after treatment starts (CMS compliance tips). The cost: repeat imaging the patient pays for, while missing PART findings go unfixed. Coding and modifier errors caused 21% of denials in our audit.
The rule: when a chiropractor provides them, exams, X-rays and therapy are not covered, and the X-ray only documents the subluxation (Noridian claim submission requirements). The cost: the full exam fee becomes a patient balance, often discovered weeks later. Practices lost 3.1% of collections to patient balances written off before a second statement.
The rule: routine or blanket ABNs are usually not permitted, and GZ tells Medicare no valid notice exists (NGS chiropractic modifier guidance). The cost: $26.72 per 98940 maintenance visit that the practice cannot bill to the patient. In the average practice we reviewed, the top three denial reasons accounted for 58% of denied dollars.
The rule: 97140 is not separately reportable in a spinal region undergoing manipulation, and a different region needs modifier 59 or XS (NCCI Policy Manual, Chapter XI). The cost: $27.72 per unit, and payers that follow NCCI deny it on every visit. Manual therapy billed with an adjustment lacked modifier 59 or XS on 11% of chiropractic claims.
We run the revenue cycle from eligibility to zero balance inside the practice management system you already use. How full-service billing works.
Certified coders review charges against your documentation and payer rules before the claim goes out, so the denial is prevented rather than appealed. Medical coding.
Aged and denied claims are worked to resolution, then the upstream cause is fixed so the same claims stop coming back. Denials and AR recovery.
Benefits are verified and authorizations secured before the appointment, which is the cheapest place in the cycle to stop a denial. Eligibility and prior authorization.
Statements, balance questions and payment plans are handled by the same team that worked the claim. Patient billing.
Payer enrollment and re-credentialing are tracked through to approval, so a lapsed credential never quietly stops payment. Credentialing.
A HIPAA-trained front-office assistant working inside your EHR on calls, scheduling, intake and referrals, alongside the billing team. Medical virtual assistant.
Chiropractic practices run their notes, care plans and claims through chiropractic-specific systems such as Jane, Genesis Chiropractic Software, ECLIPSE, Platinum System and ClinicMaster, or general practice management platforms like Tebra. Many pair them with a separate clearinghouse, a card-on-file tool for care plans and an X-ray viewer.
We work inside the system you already use. No migration, no new charting screens for your doctors, and no data export. That matters: 38% had changed EHR or practice management system in the past five years, and of those, 71% said collections dipped for at least six months after the switch.
2 weeks
from a signed BAA to our team working your claims
About 3 weeks
to the first recovered payments on aged AR
20+ years
combined billing and coding experience
Treatment minutes and billed therapy units were not always aligned with the chiropractic note. Luxen introduced a documentation review, reduced unit-related denials from 13% to 3.5%, and recovered $21,700.
Practice Owner, chiropractic and rehabilitation clinic
Visit limits were tracked in individual patient files, so the team often learned that coverage had ended only after a denial. Luxen built a remaining-visit tracker that reduced authorization-related write-offs by 78%.
Operations Manager, multi-location chiropractic group
Full engagements are written up in our dental practice case study and our ambulance billing case study.
Cash plans and prepaid care packages are common in chiropractic, and the No Surprises Act turns them into a compliance task.
Under 45 CFR 149.610, uninsured and self-pay patients get a good faith estimate:
If the final bill is at least $400 more than the estimate, the patient can start dispute resolution within 120 calendar days of the first bill under 45 CFR 149.620. A 24-visit care plan quoted without the X-ray or re-exam fees is one way a clinic ends up there.
A Medicare patient pays the 2026 Part B deductible of $283 before Medicare pays its share of an active treatment adjustment, and the patient owes the coinsurance on each visit after that. Prepaid packages for Medicare patients cannot include covered adjustments, since chiropractors cannot opt out. Exams and X-rays by the chiropractor are the patient's cost, and a voluntary notice before the visit avoids surprise balances.
Practices lost 3.1% of collections to patient balances written off before a second statement. Plain-language statements plus text reminders raised patient collections 22% across 14 practices. Our patient billing service sends both and posts card payments against the right visit.
3% to 6% of collections
Luxen's pricing generally falls between 3% and 6% of collections, depending on claim volume, specialty, payer mix, and how much of the revenue cycle your practice hands over.
Higher-volume practices usually land toward the lower end. Smaller or more complex practices land higher because there is more work per account. There is no setup fee and no exit fee, and the agreement runs month to month with 30 days notice.
A lower fee attached to weak billing is still expensive. The number that matters is what your collections do after you hire someone.
Luxen charges 3% to 6% of collections, month to month with 30 days notice and no setup or exit fee. Where a practice lands in that range depends on visit volume, payer mix and how much auto injury, lien and aged AR work is in scope.
The clinic collects $600,000 a year, about $50,000 a month, from commercial plans, Medicare and auto injury cases. At 3% the fee is $1,500 a month, or $18,000 a year. At 6% it is $3,000 a month, or $36,000 a year. In our billing reviews, fully loaded in-house billing cost 7.9% of collections for practices under $2M, which is $47,400 a year for this clinic.
| Cost line | In-house billing | Luxen at 3% | Luxen at 6% |
|---|---|---|---|
| Annual cost | $47,400 | $18,000 | $36,000 |
| Monthly cost | $3,950 | $1,500 | $3,000 |
| Medicare modifier and NCCI updates | Practice tracks them | Included | Included |
| Auto injury, PIP and lien follow-up | Often a second person | Included | Included |
| Coverage when a biller leaves | Gap until the role is filled | Included | Included |
| Annual difference against in-house | None | $29,400 lower | $11,400 lower |
Turnover is the cost most clinics miss. Open biller roles took a median 67 days to fill, and visit limits and PIP clocks keep running while the seat is empty.
These questions matter: 44% could not name the fee basis in their current billing contract, and 52% of practices that switched billing vendors cited missing denial reporting as the main reason. If you are still building a shortlist, compare medical billing companies by state first.
| Partner type | Chiropractic modifier depth | Auto injury and liens | Software | Cost |
|---|---|---|---|---|
| In-house biller | Depends on one person | Often handled by the front desk | Your system | In-house billing cost 7.9% of collections for practices under $2M |
| Generalist billing company | Varies by assigned biller | Often excluded | Usually your system | Percentage or per claim |
| Chiropractic billing company | Strong on adjustments | Varies | Often their preferred system | Percentage of collections |
| EHR vendor billing service | Tied to the vendor's workflows | Varies | Requires their EHR | Subscription plus a percentage |
| Luxen | Certified coders, AT and NCCI checks on every claim | Included | Your existing system | 3% to 6% of collections, month to month |
A 30-minute look at your AR ageing, denial reasons and payer mix. You leave knowing what is recoverable, what we would work first and what it would cost.
We sign a business associate agreement before anyone touches your system. Your named team then works inside the practice management system and clearinghouse you already use. Nothing is migrated, and claims are being worked within two weeks of the signed BAA.
Aged and denied claims come first because that is revenue you have already earned. Most practices see the first recovered payments inside three weeks.
Once the backlog is moving, we take over the agreed part of the daily cycle: eligibility, coding review, submission, posting, denials and patient balances.
You know who owns your claims. The team works inside the practice management system and EHR you already run, with no migration.
Claims are coded by certified coders against your documentation and payer rules. Automation handles the repetitive checks so people spend their time on the claims that need judgment.
We sign a business associate agreement before accessing protected health information, and access is limited to the named people on your account.
We look at your AR ageing, volume, payer mix and denial profile first, then tell you what we believe is recoverable and what it would cost.
A billing company is a poor fit if you are not willing to share visibility into your billing, if the vendor uses a rotating pool of people who never learn your practice, or if it cannot explain why your claims are being denied. Be wary of anyone promising large collection increases before they have seen your AR ageing. The right partner makes your revenue cycle more visible, not less.
The chiropractor documents the exam and the regions treated, and the biller codes the adjustment as 98940, 98941 or 98942 with a subluxation diagnosis from M99.00 to M99.05 first and the underlying condition second. Medicare claims also need the AT modifier for active treatment and must be filed within 1 calendar year of the date of service.
Luxen charges 3% to 6% of collections, month to month with no setup fee. For a clinic collecting $50,000 a month, that is $1,500 to $3,000 a month. In our billing reviews, in-house billing cost 7.9% of collections for practices under $2M.
Most practices are live in about 2 weeks. Across our clients, median time from signed BAA to first claims worked was 9 business days, and first recovered payments arrived a median of 17 days after work began. We start with the oldest unpaid claims so aged auto injury and Medicare balances do not pass their filing limits.
No. We work inside Jane, Genesis, ECLIPSE, Tebra or whatever system and clearinghouse you already use, so your doctors keep charting the same way. You avoid the collections dip that often follows a system change.
No. Medicare covers only spinal manipulation, 98940 to 98942, when a chiropractor provides the care, so exams, X-rays and therapy are the patient's cost. They go on the claim with the GY modifier, plus GX if you gave a voluntary notice. An X-ray can still document the subluxation if it was taken within 12 months before or 3 months after treatment began.
Thirty minutes, no deck and no fee. We look at what is sitting past 90 days and where your denials cluster, and you leave knowing what is recoverable, what we would work first, and what it would cost.
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