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Start with benefits and eligibility (tip 7), then review coding references (tip 12), claim submission (tip 14) and filing limits (tip 17). Continue with claim status (tip 23), denial review (tip 29) and remittance review (tip 31). For additional study, see the Medicare training resource in tip 9 and the claim-form instructions in tip 35. Use this article as a reading guide, not as a code-selection tool or a replacement for the requirements of the specific payer and plan.
For Medicare, ask for the Medicare card and MBI. Request an SSN only when a specific, justified workflow calls for it, rather than making it a universal intake requirement. [2][23]
If there is ever a discrepancy between parties, you always have proof.
Review the payer’s response before resubmitting. Correct inaccurate claim information through the payer’s correction process; use its reconsideration or appeal process when you disagree with a payment or denial. For example, UnitedHealthcare distinguishes corrected claims from requests to reconsider payment. Follow the instructions and deadlines for the specific plan. Sources: UnitedHealthcare 2026 provider guide.
Do not assume payers never announce changes. UnitedHealthcare’s provider guide points to published policy, product and reimbursement updates and offers email notifications. Monitor each payer’s current notices and follow its designated submission instructions. Sources: UnitedHealthcare 2026 provider guide.
When you call insurance companies, never forget to jot down the phone number, name of the representative you spoke to, what they are going to do and when, and a reference number.
Confirm that entries are saved before leaving the page, and use the system’s own navigation controls when its instructions require them. [3][19]
Check eligibility, benefits, network status and any required prior authorization for the planned services. Verify the patient’s actual cost-sharing rather than treating every balance as collectible. For example, UnitedHealthcare identifies final member responsibility on the EOB or provider remittance advice; its guide also addresses estimates collected before adjudication and refunds of excess collections. Apply the rules for the patient’s particular plan. Sources: UnitedHealthcare 2026 provider guide.
When a patient reports an insurance change, verify which coverage applied on the date of service before submitting or correcting the claim. Do not assume the new plan covers an earlier visit. UnitedHealthcare cautions that eligibility checks do not guarantee payment; actual reimbursement depends on the service dates, benefit terms and other requirements. Sources: UnitedHealthcare 2026 provider guide.
The Centers for Medicare & Medicaid Services offers free courses on how to bill for and work with Medicare through CMS Medicare Learning Network (MLN) web-based training.
You must have a system in place that promptly notifies you of receivables and allows you to easily access information about claims when necessary.
If you’re unclear about something while on the phone with an insurance company, do not hesitate to ask them for assistance–they are more likely to give you an answer if you just ask.
Do not treat a general web search result as coding validation. CMS’s Medicare billing guide identifies ICD-10-CM for diagnosis coding and points to CDC’s electronic code resources. Check the applicable coding reference and ensure the medical record supports the services billed. Sources: CMS Medicare Billing: CMS-1500 & 837P; CMS chiropractic documentation checklist.
Some insurance companies use different claim addresses by department or route chiropractic claims through a third-party administrator, which increases the risk of sending a claim to the wrong payer address or payer ID and having it rejected or denied.
CMS generally requires initial Medicare claims to be submitted electronically, but Administrative Simplification Compliance Act waivers and exceptions exist. Check the applicable requirements before choosing electronic or paper submission. Electronic filing alone is not a promise of reimbursement within a particular number of days. Sources: CMS Medicare Billing: CMS-1500 & 837P; CMS: checking Medicare claim status.
Payment timing is not the same as coverage or claim approval. CMS explains that Medicare clean claims have a waiting period before payment and that processing can take longer when the contractor needs more information. Monitor the claim’s status and follow the payer’s instructions instead of assuming every claim will pay within 30 days. Sources: CMS: checking Medicare claim status.
A custom email address does not, by itself, establish HIPAA compliance. HHS says covered entities must assess how electronic protected health information is transmitted, select appropriate protections and document the decision. Evaluate access controls, integrity and transmission security instead of treating a free or paid email address as proof of compliance. Sources: HHS: email transmission security.
Record the filing deadline for the specific payer, plan and claim. For Medicare fee-for-service, CMS generally requires filing with the correct Medicare Administrative Contractor no later than one calendar year after the date of service, with limited exceptions. Do not substitute a generic 90-day-to-18-month range for the applicable rule. Sources: CMS Medicare Billing: CMS-1500 & 837P.
Set an internal submission target that leaves time to resolve errors before the applicable payer’s filing deadline; distinguish that target from the payer’s actual deadline. [4][5]
Follow the payer’s current instructions for claim corrections and disputes instead of assuming fax is fastest. UnitedHealthcare’s provider guide describes electronic claim submission and separate reconsideration and appeal procedures. Use the route appropriate to the issue and retain proof of submission. Sources: UnitedHealthcare 2026 provider guide.
Do not assume a universal per-claim charge or that direct submission is always the better option. [18][25]
In order to create an Aging Report, you must be consistently posting your paid claims in your software and keeping a list of unpaid claims at the same time.
Maintain records supporting the services billed and send the documents required for the claim or requested by the payer. Not every initial claim requires attachments: UnitedHealthcare’s guide says some claims need supporting information for initial review and that it requests additional information when needed. For Medicare chiropractic claims, the medical record must support the billed services. Sources: UnitedHealthcare 2026 provider guide; CMS chiropractic documentation checklist.
Distinguish a claim still in process from a rejection or a payment dispute. UnitedHealthcare tells providers not to submit a second claim when the first has been accepted and is still processing. For a rejection, review the response and correct the problem; for a payment dispute, follow the applicable reconsideration or appeal procedure. Sources: UnitedHealthcare 2026 provider guide.
Do not confuse permitted patient cost-sharing with the difference between your charge and a contracted allowance. For example, UnitedHealthcare’s 2026 guide identifies copayments, deductibles and coinsurance as member responsibility and prohibits additional fees for covered services beyond those amounts. Confirm the applicable contract, plan rules and patient protections before billing. Being out-of-network is not a blanket authorization to collect every unpaid balance. Sources: UnitedHealthcare 2026 provider guide.
Don’t submit implied codes, codes that are not documented by medical necessity, unbundle codes for the sake of additional reimbursement, or select a procedural code that is similar to the actual service provided.
Follow up on unexplained delays through the payer’s designated process and check any applicable late-payment or interest rules; do not infer a payer’s motive from the age of a claim alone. [5][10]
Oftentimes claims will be rejected at the clearinghouse, insurance companies will be updating their systems, or your billing software will malfunction for you, but it’s important that you express these problems to the companies that provide these services with courtesy and compassion–you’re on the same team!
Do not treat a second same-day visit as automatically covered. CMS says Medicare typically reimburses one chiropractic manipulation per patient per day; more than one may be covered in some cases when medically necessary. Check the relevant coverage policy and documentation requirements rather than relying on a phone call as a payment guarantee. Sources: CMS chiropractic documentation checklist.
Read the denial reason and supporting remittance information. If claim details are wrong, use the payer’s correction process; if you disagree with the decision, follow the applicable reconsideration or appeal process and submit supporting documentation within its deadline. UnitedHealthcare’s guide distinguishes these routes. A denial does not automatically mean that more information will make the service payable. Sources: UnitedHealthcare 2026 provider guide.
Determine which payer is primary, submit to that payer first, and follow the applicable secondary payer’s submission and documentation rules. Do not treat “handled” as a universal requirement that the primary claim must be finally paid or closed: Medicare may make conditional payments in specified circumstances while a primary-payer decision is pending. These are limited Medicare rules, not permission to bypass the primary payer or a guarantee of payment; check the CMS guidance and the claim’s circumstances.
Source: CMS Medicare Secondary Payer booklet (July 2025), pages 12–14 and 16–18.
Investigate unexplained differences and use the payer’s correction, reconsideration or appeal process when the payment does not match the amount properly due. [5][22]
Determine whether the planned service requires prior authorization, notification or a referral under the patient’s plan. UnitedHealthcare’s guide directs providers to check these requirements before claim submission. Do not assume that most plans waive authorization or that one plan’s rule applies to another. Sources: UnitedHealthcare 2026 provider guide.
HIPAA does not categorically prohibit email with patients. HHS permits treatment-related email communications with reasonable safeguards, such as checking the recipient address and limiting the information disclosed. Transmissions of electronic protected health information must also satisfy the Security Rule’s requirements. Follow the practice’s documented privacy and security procedures and accommodate reasonable confidential-communication requests. Sources: HHS: email with patients; HHS: email transmission security.
Store credentials in a securely managed password manager with access limited to authorized staff, and preserve individual user accounts and accountability rather than sharing a general login list. [11][27]
Learn how to fill out a CMS-1500 form in the NUCC 1500 Claim Form Instruction Manual (v13.0).
Do not assume every submission was accepted or that rejections are never communicated. UnitedHealthcare directs providers to check claim status and review clearinghouse reports, Smart Edits, EDI or letter communications about rejections. Resolve the reported issue and confirm acceptance within the applicable filing limit. Sources: UnitedHealthcare 2026 provider guide.
Always check whether planned procedures need prior authorization.
You should be monitoring your accounts receivable daily, making sure claims have been received while monitoring aging reports and taking action on any outstanding accounts–or source out your chiropractic billing to someone who will stay on it.
Resolve diagnosis-code selection using the applicable ICD-10-CM guidelines, the medical record, the treating provider and qualified coding support; confirm relevant payer requirements separately. [7][13][5]
All patient information must be protected, including demographic, insurance, and billing information, as well as treatment notes.
Do not apply a universal in-network or out-of-network reimbursement percentage. Check the patient’s plan benefits, the applicable allowance and contract, and the adjudicated patient responsibility. UnitedHealthcare explicitly cautions that eligibility verification does not guarantee payment or coverage in a specific amount. Sources: UnitedHealthcare 2026 provider guide.
COBRA continuation coverage is not simply a new monthly enrollment. The U.S. Department of Labor explains that plans must offer monthly premium payments and must provide a grace period for ongoing payments. Verify the patient’s coverage with the plan, including whether a premium-related suspension or reinstatement affects the date of service, rather than assuming a missed monthly due date immediately ends coverage. Sources: U.S. Department of Labor: COBRA guide.
Check acceptance and rejection reports earlier, and set payment-status follow-up intervals around the payer’s processing guidance and filing or dispute deadlines. Record claim numbers, payment details and next steps. [5][10]
For Medicare active or corrective treatment of acute or chronic spinal subluxation, CMS requires the AT modifier for CPT codes 98940, 98941 and 98942. Do not use AT for maintenance therapy. The modifier alone does not establish medical necessity: the record must support active or corrective treatment, and applicable Medicare coverage requirements still apply. Sources: CMS: chiropractic documentation checklist.
Choose software that supports your ERA workflow, and follow its instructions for reviewing and applying payments and adjustments. For example, Office Ally’s Practice Mate provides an Auto-Post workflow, but its guidance says ERAs containing negative amounts cannot be processed by Auto-Post and may need manual entry and application. Check the vendor’s current instructions rather than assuming every ERA can be posted automatically.
When you know the contracts you have with insurance companies inside and out, you will be able to handle claims faster and deal with any changes or updates that may be made to said contracts.
Find current CPT coding resources on the American Medical Association (AMA) CPT page.
Before additional visits, verify remaining coverage and whether the specific plan permits an extension or requires a new authorization; use its designated process and keep the decision. Do not assume approval overrides benefit limits or guarantees payment; applicable law and plan rules still govern. [14][15][5]
If you have multiple outstanding claims in your Aging Report, inquire about all of them in one single call.
Extra time alone does not make a service separately payable, but qualifying timed services may support additional units when coverage and provider-eligibility rules permit. Do not apply therapy time rules to chiropractic manipulation or assume Medicare covers other services performed by a chiropractor. [16][21][24]
If you want help putting these tips into practice, see our chiropractic billing services and our billing services buyer’s guide.
This table covers Original Medicare (Part B) only. Commercial plans, Medicare Advantage, workers’ compensation and auto insurers set their own rules, so check each payer’s policy. Every row comes from the CMS sources listed under the table.
| Code or item | What it is | Medicare rule | Source |
|---|---|---|---|
| CPT 98940 | Spinal chiropractic manipulative treatment, one to two regions | Paid only as active or corrective treatment of a spinal subluxation. Needs the AT modifier. | [1] |
| CPT 98941 | Spinal chiropractic manipulative treatment, three to four regions | Same rule as 98940. Needs the AT modifier. | [1] |
| CPT 98942 | Spinal chiropractic manipulative treatment, five regions | Same rule as 98940. Needs the AT modifier. | [1] |
| CPT 98943 | Manipulation of extraspinal regions (head, upper and lower extremities, rib cage, abdomen) | Not covered by Medicare. | [2] |
| AT modifier | Active treatment | Required on 98940, 98941 and 98942 for active or corrective treatment of acute or chronic subluxation. Do not use it for maintenance therapy. Claims without AT are treated as maintenance therapy and denied. AT alone does not prove the service was reasonable and necessary. | [1] [3] |
| GA modifier | A signed Advance Beneficiary Notice (ABN) is on file | Used with a signed ABN when the chiropractor bills with AT but believes Medicare is likely to deny the service as not medically necessary. | [2] [3] |
| GZ modifier | Used in rare instances in place of GA | Medicare contractors automatically deny claim lines submitted with GZ. GA and GZ on the same service make the line unprocessable. | [3] [5] |
| Primary diagnosis | The subluxation, at its precise level | Listed first on the claim. The WPS billing article lists M99.00 to M99.05 (segmental and somatic dysfunction of the head, cervical, thoracic, lumbar, sacral and pelvic regions). Check the article for your own Medicare contractor. | [2] |
| Secondary diagnosis | The neuromusculoskeletal condition that made treatment necessary | Listed after the subluxation and coded to the highest level of specificity. | [2] |
| CMS-1500 Item 14 | Date of the initial treatment, or of the exacerbation of the existing condition | Must be entered on the claim. | [4] |
| Proof of subluxation | X-ray or physical exam | An X-ray taken within 12 months before or 3 months after the start of treatment, or an exam that documents at least 2 of the 4 PART criteria (pain, asymmetry or misalignment, range of motion abnormality, tissue tone changes). One of the two must be asymmetry or misalignment, or range of motion abnormality. | [1] |
| Other services | Exams, X-rays, physiotherapy, traction, supplies and similar services | Excluded from Medicare coverage when ordered or performed by a chiropractor. | [2] |
| Treatments per day | Number of manipulations | Medicare typically pays for only one chiropractic manipulation per patient per day. More than one may be covered if medically necessary. | [1] |
Sources: [1] CMS MLN1232664, Medicare Documentation Checklist & Guidelines for Chiropractic Doctors (April 2025). [2] CMS Billing and Coding: Chiropractic Services, article A56273 (WPS, revised 08/28/2025). [3] Medicare Benefit Policy Manual, Chapter 15, Section 240.1.3. [4] Medicare Claims Processing Manual, Chapter 12, Section 220. [5] Medicare Claims Processing Manual, Chapter 23, Section 20.9.1.1.
CPT codes are copyright American Medical Association. This table is a billing reference, not coding or legal advice.
On Medicare claims, the AT (active treatment) modifier identifies chiropractic manipulative treatment (CPT 98940, 98941 or 98942) as active or corrective treatment of an acute or chronic subluxation. CMS says Medicare requires it to pay those codes and that it should not be used for maintenance therapy. The modifier alone does not prove medical necessity; the record still has to support active treatment. CMS also reports that a 2024 CERT review found errors in 33.6% of chiropractic claims.
Source: CMS MLN1232664: Medicare Documentation Checklist & Guidelines for Chiropractic Doctors
The chiropractic manipulative treatment codes are selected by the number of spinal regions treated: 98940 for one to two regions, 98941 for three to four regions and 98942 for five regions. For Medicare, the chiropractor must also document the precise level of subluxation, and CMS lists failure to document all treated spinal regions as a common denial reason.
Source: Medi-Cal Chiropractic Services Codes; CMS Medicare Benefit Policy Manual, Chapter 15; CMS MLN1232664: Medicare Documentation Checklist & Guidelines for Chiropractic Doctors
No. Medicare Benefit Policy Manual Chapter 15, Section 240.1.3 limits chiropractic coverage to manual manipulation of the spine to correct a subluxation. CMS states that no other diagnostic or therapeutic service furnished by a chiropractor or under the chiropractor’s order is covered, including an x-ray the chiropractor orders, takes or interprets. Commercial and Medicare Advantage plans set their own rules, so verify benefits for each plan.
Source: CMS Medicare Benefit Policy Manual, Chapter 15
CMS advises chiropractors to consider getting a signed Advance Beneficiary Notice of Noncoverage (ABN) from patients for services Medicare may not cover, such as maintenance therapy. The ABN should explain why Medicare may not pay and include the patient’s acknowledgement of financial responsibility. Include a copy of the ABN in records sent to a Medicare contractor when applicable, and check the CMS claims manual for the ABN-related claim modifiers.
Source: CMS MLN1232664: Medicare Documentation Checklist & Guidelines for Chiropractic Doctors
Alex is a chiropractic billing expert, and helps chiropractors collect more revenue as Owner of eChiro Billing.