Chiropractic billing lives inside Medicare restrictions, commercial session caps, and PIP arbitration. We bill acute care with the AT modifier, manage visit caps, and recover PIP underpayments through arbitration when warranted.
We see the same patterns across chiropractic groups. The leaks are specific, recurring, and fixable with coding discipline and payer-aware claim construction.
Not a complete list. A representative slice of the codes that drive revenue and denials for chiropractic practices.
| Code | Description | Profile |
|---|---|---|
| 98940 | CMT, 1 to 2 spinal regions | High volume |
| 98941 | CMT, 3 to 4 spinal regions | Modifier-sensitive |
| 98942 | CMT, 5 spinal regions | Denial-prone |
| 97014 | Electrical stimulation, unattended | High volume |
| 97012 | Mechanical traction | Modifier-sensitive |
| 97110 | Therapeutic exercise | Denial-prone |
| 97035 | Ultrasound therapy | High volume |
AT modifier applied on acute CMT. Maintenance care documented and billed to patient when insurance does not cover. PIP claims billed with attention to fee schedule and arbitration when underpaid. E/M plus CMT on same day billed with modifier 25 when supported.
Pattern we see. Medicare CMT denied without AT modifier, modality bundling (97014 with some other codes), and PIP underpayments that require arbitration to recover.
How we fix it. Every denial is logged against its CARC/RARC code and routed to a coder who owns the appeal. We rebuild the claim with the documentation the payer is actually asking for, not a generic reconsideration letter. Recovery rate on appealable chiropractic denials averages above 60 percent.
A written 30-day diagnostic. Dollar figures against every finding. No obligation.