Chiropractic care plays a critical role in non-invasive, drug-free treatment for musculoskeletal issues. However, billing for chiropractic services is often far from simple. Chiropractors deal with strict payer policies, limited covered services, and heavy documentation requirements — making chiropractic billing a specialty of its own.

At Progressive RCM, we understand these unique challenges. Our dedicated team offers chiropractic billing services that improve accuracy, speed up payments, and ensure full compliance with both Medicare and private insurers. Whether you’re a solo practitioner or run a multi-provider clinic, we help you get paid for every adjustment you provide.

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The Unique Challenges of Chiropractic Billing

Chiropractic practices face billing obstacles that are rarely seen in other specialties. These include:

1. Limited Covered Services

Many insurance companies cover chiropractic care only for medically necessary spinal manipulations, often requiring specific ICD-10 codes and documentation. Services like massage therapy or wellness adjustments may not be reimbursed.

2. Documentation Intensity

To prove medical necessity, providers must document the subluxation, treatment plan, initial evaluation, and progress notes. Missing or vague documentation can lead to denials.

3. Modifier Usage

Proper use of modifier AT (Active Treatment) is essential for distinguishing between medically necessary and maintenance care — especially for Medicare.

4. Visit Limits and Frequency Caps

Payers often restrict the number of chiropractic visits per year. Exceeding this without medical justification may result in non-payment.

5. Complex CPT Code Application

Using the right CPT codes for spinal manipulation, therapeutic procedures, and exams requires experience. Incorrect coding can trigger audits.

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Progressive RCM’s Chiropractic Billing Services

At Progressive RCM, we offer a full suite of chiropractic billing services tailored to the unique needs of your practice.

✅ Accurate Chiropractic Coding & Documentation

Our certified coders specialize in CPT, ICD-10, and HCPCS coding for chiropractic care. We ensure proper use of:

• 98940 – Spinal manipulation (1-2 regions)

• 98941 – Spinal manipulation (3-4 regions)

• 98942 – Spinal manipulation (5 regions)

• 97110 – Therapeutic exercises

• 97112 – Neuromuscular re-education

• 97010 – Hot/cold packs

• 97035 – Ultrasound therapy

We also help you document subluxation diagnosis, treatment goals, and re-evaluations — ensuring full compliance and reimbursement.

✅ Medicare-Compliant Billing

Medicare only pays for active treatment, not maintenance. We apply modifier AT appropriately and ensure proper charting to prevent audits and denials.

✅ Claims Submission & Payer Compliance

We submit clean claims within 24–48 hours and format them according to each payer’s chiropractic billing rules, including local coverage determinations (LCDs).

✅ Denial Management & Appeals

Our AR team reviews all denied or rejected claims, corrects documentation issues, and submits appeals with the right medical necessity proof.

✅ Verification of Benefits

Before care begins, we verify a patient’s chiropractic benefits, visit limits, deductibles, and co-pays — so there are no surprises later.

✅ Patient Billing & Collections

We send clear, timely patient statements and offer flexible payment options to keep your collections high and patient satisfaction intact.

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Chiropractic Services We Bill For

We accurately code and bill for a wide range of services, including:

• Spinal adjustments (CMT)

• Therapeutic exercises and activities

• Manual therapy

• Electrical stimulation

• Ultrasound therapy

• Mechanical traction

• Hot and cold pack therapy

• Functional capacity evaluations

• Initial exams and re-exams

• Wellness and maintenance care (with self-pay handling)

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Our Chiropractic Billing Workflow

1. Insurance Eligibility Check
   We verify chiropractic benefits and coverage restrictions before care starts.

2. Accurate Charge Entry
   We use time-based coding and apply region-specific codes and modifiers correctly.

3. Claim Submission
   Claims are submitted electronically within 1–2 business days.

4. Payment Posting & Reconciliation
   We post payments daily and reconcile them with EOBs to detect underpayments.

5. Denial Analysis & Appeals
   We address payer denials quickly and provide documentation to justify services.

6. Patient Billing & Follow-Up
   We send statements, manage payment plans, and reduce aging accounts.

7. Monthly Reporting
   You get detailed financial reports including collection rates, denial trends, and revenue growth.

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Why Choose Progressive RCM for Chiropractic Billing?

✅ Chiropractic-Specific Billing Knowledge
Our coders understand chiropractic care, from spinal manipulation codes to Medicare documentation rules.

✅ Proper Modifier Use (AT, GA, GY)
We ensure correct use of modifiers required by payers and Medicare.

✅ Payer-Specific Rule Tracking
Each insurance provider treats chiropractic differently — we stay current on all payer requirements.

✅ Medicare & Medicaid Expertise
We help you bill active treatment correctly and stay compliant with LCDs and CMS guidelines.

✅ Integrated Technology
We work with systems like ChiroTouch, Eclipse, Kareo, Jane, DrChrono, and more.

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Key Metrics We Track

• First-pass claim acceptance rate

• Claims denied due to missing documentation

• Number of visits per patient reimbursed

• AT modifier compliance

• Underpayment and reimbursement variance

• Days in Accounts Receivable

• Patient collections success rate

These KPIs help us identify billing inefficiencies and optimize your chiropractic revenue cycle.

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Final Thoughts

Running a chiropractic practice is demanding enough without the added stress of complicated billing. With strict insurance limits, documentation requirements, and payer-specific rules, your revenue cycle depends on getting the details right.

Progressive RCM specializes in chiropractic billing that’s precise, fast, and fully compliant. We help you focus on healing patients while we take care of your collections, denials, and documentation.