Everything a Chiropractic Practice Needs

Chiropractors are licensed state by state, and each state board sets its own application requirements and continuing education rules. A new license typically draws on your chiropractic school transcript, your National Board of Chiropractic Examiners score transcript and verifications of every license you hold, plus whatever else that board asks for.

Medicare also depends on your state license. A chiropractor must be licensed or legally authorized by the state where the services are furnished, and coverage extends only to manual manipulation of the spine to correct a subluxation where that treatment is legal in the state. We keep every license current so your billing privileges are never at risk because a renewal slipped.

Most chiropractic revenue still comes from insurance, so being in the right networks matters. We find out which commercial, Medicare Advantage and Medicaid plans are open to chiropractors in your area, complete each application, build and attest your CAQH ProView profile, and follow up until each contract has an effective date.

Medicare enrollment works differently for chiropractors than for many physicians. You must enroll in Medicare to submit claims for covered manipulation, and chiropractors cannot opt out of Medicare to treat patients under private contracts. If you see Medicare patients at all, your enrollment and your billing policy need to be set up together.

Under Medicare, a chiropractor counts as a physician only for manual manipulation of the spine to correct a subluxation. Chiropractors bill three codes: 98940 for one to two spinal regions, 98941 for three to four regions, and 98942 for five regions. Hand-held manual devices may be used, but Medicare pays nothing extra for them.

Every other service a chiropractor furnishes or orders is not covered by Medicare. If you order, take or interpret an x-ray or another diagnostic test, it can be used to document the subluxation, but Medicare does not pay for it. Examinations, therapies and supplies fall outside the benefit as well.

The AT modifier marks active or corrective treatment of an acute or chronic subluxation, and Medicare requires it to pay 98940 through 98942. Claims without it are treated as maintenance therapy and denied. The modifier does not prove the service is necessary; contractors can still deny it on medical review if the record does not support active treatment.

Medicare requires a subluxation to be shown by imaging or by physical examination. An x-ray must generally be taken within 12 months before or 3 months after the start of treatment, and a CT scan or MRI showing the subluxation is also acceptable. On physical examination, the record must show at least two of the four PART findings, pain or tenderness, asymmetry or misalignment, range of motion abnormality, and tissue or tone changes, and one of the two must be asymmetry or range of motion abnormality.

The initial visit note needs the history, symptoms tied to the level of subluxation, the examination, a primary diagnosis of subluxation that names the level, a treatment plan and the date of first treatment. A note that says only that the patient has pain is not enough: it must describe where, and which vertebra could cause pain there. Later visits need a review of the complaint, an exam with at least two PART elements, an assessment of change since the last visit and the treatment given.

Once a condition is stable and further clinical improvement is not expected, care becomes maintenance therapy, which Medicare does not cover. Acute problems may need up to about three months of treatment, with visits becoming less frequent. When you expect Medicare to deny a visit, the patient should sign an Advance Beneficiary Notice before the service, and the claim carries the GA modifier. If no ABN was signed, the GZ modifier marks the claim instead, and the patient cannot be billed for a denied visit.

Many chiropractic clinics combine insurance with cash care plans, wellness memberships and personal injury cases. Each needs its own fee schedule, its own paperwork and a clear line between what is billed to a payer and what the patient pays directly. We set up your pricing, packages and memberships, and we reconcile cash collections with the rest of your revenue every month.

Medicare patients need extra care. Because chiropractors cannot opt out, you cannot sell a Medicare patient a private contract for covered manipulation. Maintenance visits can be the patient's responsibility when the patient has signed an ABN, and services Medicare never covers when a chiropractor provides them, such as examinations and x-rays, are outside the benefit. We help you write a policy for Medicare patients that follows these rules.

Most chiropractic documentation problems start in the chart. We set up your EHR with visit templates that prompt for the PART findings, the level of subluxation, the regions treated and progress against the treatment plan, so the note supports the code and the AT modifier without extra typing. Scheduling, online intake and e-signature for ABNs and financial policies are set up in the same system.

For cash and membership patients, your patient portal handles care plan payments, memberships, superbills and records on your own domain, so patients can pay and download what they need without calling the front desk.

Chiropractic claims draw a lot of review. CMS's own documentation checklist cites a 2024 review that found errors in 33.6% of chiropractic claims and notes that insufficient documentation is a common issue. The most common denial reasons include missing or inadequate treatment plans, an unclear chief complaint and failure to document every treated spinal region, and failing to respond to an additional documentation request is a major reason claims are denied. Prolonged or repeated treatment is more likely to be reviewed.

We answer documentation requests on time with complete records, an abbreviation key and any ABN on file. We also run your HIPAA security risk assessment, write your policies, train your front desk and collect business associate agreements from every vendor that handles patient data.

Chiropractic is a local, search-driven business. We build and run your website, local search and AI search visibility, Google and Microsoft ads, and review requests, so new patients find you and your profile shows the care you give. Your marketing and your billing are run by the same team, so the services you promote match the services your payers and cash plans actually cover.