Question 1

What is chiropractic medical billing?

Accepted Answer

Chiropractic medical billing is the process of coding chiropractic services, submitting claims to insurers, and following up until the practice is paid. It differs from general medical billing in three ways: claims rely on a narrow set of spinal manipulation codes, continued care requires documented medical necessity, and a large share of claims are paid by auto insurers and personal injury carriers rather than health plans.

A complete chiropractic billing cycle covers patient registration and eligibility verification, CPT and ICD-10 coding, claim scrubbing, electronic submission, payment posting, denial appeals, and AR follow-up. Practices either staff this internally or outsource it.

Question 2

What CPT codes do chiropractors bill?

Accepted Answer

The core chiropractic CPT codes are 98940, 98941, and 98942, which cover chiropractic manipulative treatment of the spine by number of regions treated. 98940 covers 1–2 spinal regions, 98941 covers 3–4, and 98942 covers all 5. Code 98943 covers extraspinal manipulation and is not covered by Medicare. Chiropractic offices commonly bill therapy and modality codes alongside manipulation: 97012 — mechanical traction 97014 / G0283 — electrical stimulation, unattended 97110 — therapeutic exercise 97140 — manual therapy techniques 97530 — therapeutic activities 99202–99215 — evaluation and management visits Modifier use matters as much as code selection. Manipulation and therapy billed on the same date frequently require modifier 59 or an X-modifier to clear NCCI edits, and Medicare manipulation claims require the AT modifier for active treatment.

Question 3

Why do chiropractic claims get denied?

Accepted Answer

Most chiropractic denials trace to a short list of preventable causes: missing or incorrect modifiers, documentation that doesn't establish medical necessity, care classified as maintenance rather than active treatment, exhausted visit limits, and eligibility that was never verified before the visit. The pattern we see repeatedly in practice audits: No AT modifier on a Medicare manipulation claim, which reads to the payer as maintenance care Missing modifier 59 when therapy is billed with manipulation on the same date Thin treatment notes that don't document functional improvement, so continued care fails medical-necessity review Diagnosis pointing errors where the ICD-10 code doesn't support the region billed Stale eligibility — the plan changed, the deductible reset, or chiropractic visits were capped Timely filing missed on claims sitting in a work queue nobody owned Nearly every denial above is caught before submission by a pre-audit plus an upfront eligibility check. That is the single largest source of the 30% average denial reduction MYRI practices see. Every denial that does land gets a formal appeal within 72 hours.

Question 4

What is a good first-pass claim approval rate?

Accepted Answer

First-pass approval rate is the percentage of claims accepted and paid on initial submission, with no rejection, denial, or rework. Industry benchmarks generally treat 95% or higher as strong performance. MYRI Medical Billing maintains a 97% first-pass approval rate across the chiropractic practices it bills for. The practical difference is cash timing. A clean claim pays in one cycle; a denied claim adds weeks of appeal work and, in understaffed offices, frequently never gets reworked at all. If you don't currently know your first-pass rate, that number alone is worth pulling before making any billing decision. Medicare

Question 5

Does Medicare cover chiropractic care?

Accepted Answer

Medicare Part B covers only manual manipulation of the spine to correct a subluxation, when the treatment is active and medically necessary. It does not cover chiropractic X-rays, exams, therapy modalities, massage, or maintenance care — even when performed by the same chiropractor on the same day. Because so much of a typical chiropractic visit falls outside the covered benefit, the non-covered portion has to be handled correctly on the front end or the practice absorbs it.

Question 6

What is the AT modifier and when is it required?

Accepted Answer

The AT modifier signals active treatment and must be appended to chiropractic manipulation codes billed to Medicare whenever care is corrective rather than maintenance. Without AT, Medicare treats the claim as maintenance care and denies it. AT is not a formality to append automatically. The notes have to support it — documented subluxation, a clear treatment plan, and evidence the patient is improving. When care transitions from corrective to maintenance, AT comes off and the patient becomes financially responsible.

Question 7

When does a chiropractic practice need an ABN?

Accepted Answer

A practice needs an Advance Beneficiary Notice of Noncoverage (ABN) on file before providing a service Medicare is expected to deny — most commonly maintenance care, or the exams, X-rays, and modalities Medicare never covers for chiropractors. Without a signed ABN, the practice generally cannot bill the patient for those services. Missing ABNs are one of the most common compliance gaps we find in chiropractic audits, and the cost is invisible: the revenue simply never gets billed. MYRI flags ABN-triggering services at the coding stage so the front desk collects the form before the visit, not after the denial. Personal Injury, PIP & MedPay

Question 8

What is PIP billing?

Accepted Answer

PIP (Personal Injury Protection) billing is the process of billing a patient's own auto insurance policy for treatment after a motor vehicle accident, in no-fault states. PIP pays regardless of who caused the crash, and the benefit limits, filing deadlines, and treatment-timing requirements are set by each state's statute rather than by the insurer. PIP claims usually fail for reasons unrelated to clinical care: the patient wasn't seen inside the state's required window, the crash report or claim number was never obtained, the letter of protection wasn't documented, or the carrier's initial payment was never audited against the applicable fee schedule. Each is administrative, and each is preventable.

Question 9

What is MedPay, and how is it different from PIP?

Accepted Answer

MedPay (Medical Payments coverage) is optional auto insurance that pays medical bills after an accident regardless of fault. It differs from PIP in that it covers medical expenses only — no lost wages or replacement services — and it's available in most states, including at-fault states where PIP isn't offered. Practices routinely leave MedPay money uncollected because nobody asks whether the patient carries it. In PIP states, MedPay often sits behind PIP and can pick up the balance once PIP benefits are exhausted — which, over a full course of chiropractic care, happens more often than practices expect.

Question 10

How do attorney liens work in personal injury chiropractic billing?

Accepted Answer

In a letter-of-protection or lien arrangement, the practice treats the patient now and is paid out of the patient's eventual settlement rather than by an insurer. The practice carries the balance until the case resolves, so documentation and coordination with the attorney's office determine whether it gets paid in full. The controllables are keeping the lien and LOP paperwork executed and on file, billing at the correct rate, sending updated balances to the attorney on a schedule, and tracking case status so nothing settles without the practice's bill in the file. MYRI coordinates lien billing alongside PIP and MedPay so the same accident isn't billed twice or billed to the wrong payer.

Question 11

Should a chiropractic practice outsource billing or keep it in-house?

Accepted Answer

It depends on volume and staffing, but for most small-to-mid chiropractic practices outsourcing wins on total cost and consistency. Outsourcing makes the most sense when billing is one person's part-time responsibility, when denials or AR over 90 days are climbing, or when the practice can't absorb the risk of that person leaving. In-house billing makes sense when volume justifies a dedicated, trained biller and the practice has systems to supervise the work. The honest comparison isn't the billing fee against a salary. It's the fee against salary plus benefits, plus software and clearinghouse costs, plus training and vacation and turnover coverage, plus the revenue lost to denials that never get appealed. That last figure never appears on a P&L, which is why it's usually the one that settles the question.

Question 12

How much does outsourced chiropractic billing cost?

Accepted Answer

Outsourced chiropractic billing is typically priced one of three ways: a percentage of collections, a flat fee per claim, or a bundled monthly rate. MYRI's percentage-based plan runs 3.5–5% of collected revenue, with per-claim and comprehensive monthly options available depending on practice volume. Which model fits depends on volume and how predictable your month looks: Percentage-based (3.5–5%) — aligned incentives; we're paid when you collect. Works at any practice size. Comprehensive monthly — all services bundled at a fixed rate, including credentialing and a dedicated specialist. Most popular with established practices. Per-claim flat fee — predictable cost per claim processed. Best for lower-volume practices. No hidden fees and no long-term contract requirement. Pricing is quoted after we review your actual claim volume and payer mix.

Question 13

How long does chiropractic provider credentialing take?

Accepted Answer

Credentialing a chiropractor with a commercial payer generally takes 60 to 120 days from a complete application, though timelines vary by payer and state and some panels take longer or are closed to new providers. Medicare enrollment typically falls in the same range. Delays are almost always avoidable ones: an incomplete CAQH profile, expired malpractice documentation, an NPI record that doesn't match the application, or a follow-up nobody made. Start before you need it — a new associate who isn't credentialed can't bill, and retroactive effective dates are never guaranteed.

Question 14

Do you work with our EHR or practice management software?

Accepted Answer

Yes. MYRI works inside the software your practice already uses, including ChiroTouch, Jane App, ECLIPSE, and Genesis Chiropractic. You don't switch platforms, retrain your front desk, or migrate patient data to work with us. We connect through secure, encrypted remote access to your existing system, so scheduling, documentation, and front-desk workflow stay exactly as they are. If you're between systems or billing in-house without software, tell us during the audit and we'll confirm the setup before anything is signed.

Question 15

Is 100% remote medical billing HIPAA compliant?

Accepted Answer

Yes, when the billing company operates as a business associate under a signed Business Associate Agreement and maintains the required administrative, physical, and technical safeguards. Remote work is not itself a HIPAA issue; unsecured handling of protected health information is — and that risk exists in an office just as much as outside one. MYRI executes a BAA with every practice before touching any PHI, works within your secured systems over encrypted connections rather than exporting patient data, and limits access to the specialists assigned to your account.

Question 16

Do you only serve chiropractic practices in Florida?

Accepted Answer

No. MYRI Medical Billing is headquartered in Lake Mary, Florida and bills for chiropractic practices in all 50 states. Billing is handled 100% remotely, so your location has no bearing on service and no office visit is ever required. Being Florida-based does mean we handle a high volume of no-fault PIP and personal injury work — some of the most rule-intensive chiropractic billing in the country. That experience carries directly into auto and PI claims in every other state.

Question 17

How quickly can our practice get started?

Accepted Answer

Most practices are fully onboarded and billing live within 5 business days. Setup is entirely remote — EHR integration, payer configuration for your state, workflow mapping, and team orientation — with no paperwork to mail and no in-person meetings. The sequence is a free 30-day billing audit, then custom setup inside your existing system, then live billing with monthly performance reporting on collections, denials, and claim status.

Question 18

What happens when we switch billing companies?

Accepted Answer

A well-run transition doesn't interrupt cash flow. New claims move to the incoming biller on an agreed cutoff date, while outstanding AR is either worked by the outgoing biller through wind-down or formally transferred, so nothing sits unworked in the gap between the two. The thing to settle before you give notice is who works the aging claims already submitted. That single unanswered question is where practices lose real money during a switch. We map it with you before any cutoff date is set.

Question 19

What is the free chiropractic billing audit?

Accepted Answer

It's a no-cost, no-obligation review of your last 30 days of claims, delivered as a written report within 5 business days. It covers denial patterns by payer, code and provider, CPT and modifier accuracy across 98940–98942 and E&M codes, Medicare and state-specific PI compliance, and an estimated monthly revenue recovery opportunity in dollars. The findings are yours to act on whether or not you hire us. Most chiropractic practices are losing 15–25% of collectible revenue to preventable billing errors, unworked denials, and coding mistakes — the audit tells you which of those applies to you, and how much it's worth.

Question 20

Can chiropractors bill Medicare for maintenance care?

Accepted Answer

No. Medicare does not pay for chiropractic maintenance care — it only covers manual manipulation of the spine to correct a subluxation when the care is active treatment expected to improve the patient's condition. Once care becomes maintenance or supportive, Medicare considers it non-covered. This is one of the most common sources of Medicare denials and audit risk. The AT (Acute Treatment) modifier signals active treatment, and the documentation must show a treatment plan with measurable improvement goals. When care shifts to maintenance, the correct step is an Advance Beneficiary Notice (ABN) so the patient can be billed directly — not continuing to bill Medicare as if the care were still active.

Question 21

What happens if a chiropractic claim is denied for medical necessity?

Accepted Answer

A medical-necessity denial can usually be appealed and overturned when the documentation supports the care — it is rarely the end of the claim. The appeal succeeds or fails on whether the treatment notes establish an active problem, a treatment plan, and measurable functional improvement tied to the diagnosis billed. The practical process is to identify the denial fast, pull the supporting documentation, and file a formal appeal within the payer's deadline. Denials that go unappealed are simply written off as lost revenue — which is why a consistent appeal process matters more than any single claim. MYRI appeals every denial within 72 hours rather than writing it off.

Question 22

Does insurance cover chiropractic care for auto accident injuries?

Accepted Answer

Usually yes — auto accident chiropractic care is most often paid through the patient's auto insurance rather than their health plan. In no-fault states that means Personal Injury Protection (PIP); MedPay may also apply, and in some cases the at-fault driver's liability coverage or an attorney lien covers the care. Which payer applies, and in what order, depends on the state and the patient's coverage — and getting that sequence wrong is a leading cause of unpaid accident claims. PIP has strict filing windows and treatment-timing rules, MedPay often sits behind PIP, and lien cases are paid from the eventual settlement. Coordinating these correctly is a core part of personal-injury chiropractic billing.

Chiropractic Billing Questions Answered

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