The Leading Practice Management and RCM Billing Software for Chiropractic

Chiropractic practices operate at the intersection of insurance-billed active treatment and cash-pay wellness or maintenance care, requiring strict separation between the two to remain compliant with Medicare and commercial payer policy. Spinal manipulation billing carries unique modifier requirements and documentation standards that, if mishandled, lead to recoupments and audit exposure.

Medicare reimburses spinal manipulation (CPT 98940-98943) only when active/corrective treatment is documented with the AT modifier, and any visit determined to be maintenance therapy must be billed to the patient as non-covered. Practices that blend insurance-billed active care with cash-pay maintenance and wellness plans need clear documentation triggers and separate ledgers to avoid billing maintenance care to Medicare, a common audit target.