SpecialtiesChiropractic
Chiropractic Billing for Physician and Physician Assistant
Maintenance-versus-active-treatment is the line most chiropractic denials sit on.
Why this specialty
loses money.
Chiropractic reimbursement depends on demonstrating active treatment toward a functional goal. Once documentation stops showing progress, payers reclassify the care as maintenance and stop paying — often retroactively, across a run of visits already delivered.
What makes it different
- Active treatment versus maintenance documentation
- Visit caps and frequency limits that vary by plan
- Spinal versus extremity manipulation coding
- The AT modifier and what has to support it
Many chiropractic offices have evolved from working independently to partnering with a physician and physician assistants at integrative clinics. This collaboration benefits the patient; however, because the individual providers each have unique billing policies, any confusion regarding them will lead to denials. With the help of Exact Core Group, we can assure you that all of your chiropractic providers receive proper reimbursement for your care services.
Why Chiropractic Multi-Provider Billing Can Be Tricky
The process of multi-provider chiropractic billing is much more complicated than regular solo practice since when a physician and physician assistant join the process, there is a mixture of different credentials and policies that are applied to the same day and possibly even the same patient.
Narrow Coverage for Chiropractic Services
For example, Medicare will pay for manual adjustment of the spine when there is a subluxation.Any exams, imaging, and therapy prescribed by a chiropractor are excluded. The spinal manipulation service can be coded as 98940, 98941, and 98942, which is dependent on the number of spinal regions addressed. Every commercial payer sets its own limitations on chiropractic care.
Codes Must Correlate with the Chart
Correct medical billing and coding require that the codes correlate with what is actually documented and the provider who provided the service.It is required to keep a record of the body areas being treated, the reason for the treatment, and medical necessity for each visit.
Continuation of Follow-Up After the Claims Filing Period
Submission does not mean payment. The medical billing coding staff at our company monitors all claims, deals with denials quickly, and uncovers the cause of the issue so it would not occur next month.
What Can Exact Core Group Do for Your Practice
We operate as an extension of your practice. You will get informative reports on what was billed, what was paid, and what is still pending, as well as a direct response if any claim requires clarification. We work with solo chiropractors and group clinics, adjusting to your software and payers’ policies.
Set Up a Reliable System for Medical Billing and Coding
Your medical team should be concentrated on helping your patients to avoid pains; not understanding payer requirements. Contact Exact Core Group to have your medical billing coding reviewed, and we will uncover any possible loss of revenue.
The same eight disciplines,
tuned to this specialty.
Chiropractic billing is not a separate service — it is the same revenue cycle, with the rules that matter here applied at each stage. The assessment reviews all eight against your own data.
How is chiropractic
billing performing for you?
A revenue assessment reviews all eight disciplines end to end and shows you where the reimbursement is going.