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Chiropractic Billing Services
Qualigenix provides chiropractic billing services for independent chiropractic practices: region-accurate CMT coding, AT modifier review, PART documentation checks, ABN management, denial appeals and AR follow-up, delivered remotely to practices in 48 states.
What Gets a Chiropractic Claim Paid
A chiropractic claim gets paid when the code matches the regions treated, the note proves the subluxation and active care, and the service is one the payer covers. Medicare covers only manual manipulation of the spine to correct a subluxation (CPT 98940–98942), so the AT modifier and PART documentation decide most Medicare claims. Qualigenix checks all three before a claim goes out. Book a free billing audit: 786-259-0231.
01
CMT Region Coding
CPT 98940 covers one to two spinal regions, 98941 covers three to four, and 98942 covers five. A region count the note doesn't support gets downcoded or denied on review, and a count lower than the regions treated leaves earned payment behind. Each line's diagnosis also has to support the regions billed.
02
Commercial Visit Caps
Many commercial plans cap chiropractic visits per year or approve care in blocks through a utilization-management vendor. Visits past the approved count are denied, and patients often learn about the limit only when the bill arrives.
03
Active vs Maintenance Care
Medicare pays chiropractors only for active, corrective treatment. Once the patient stops improving and care becomes maintenance, Medicare stops paying, and contractors deny manipulation billed without the AT modifier.
04
Non-Covered Services and ABNs
Exams, x-rays, therapy and extraspinal manipulation (98943) furnished by a chiropractor are not covered by Medicare. Billing them without the right modifier, or collecting from the patient without the right notice, leads to denials and compliance exposure.
05
Visit and Benefit Limits
Deductibles, copays and remaining visits reset at the start of each plan year. Practices that verify benefits only at intake find out about a used-up benefit after the visits are already done.
06
PART Documentation
Medicare accepts a subluxation shown by x-ray or by physical exam. On exam, the note must show two of the four PART findings (pain, asymmetry, range-of-motion abnormality, tissue or tone change), and one of them must be asymmetry or range of motion. Notes copied forward from visit to visit rarely hold up on review.
07
Recurring Chiropractic Denials
Three denials repeat most often: a missing or unsupported AT modifier, care reclassified as maintenance on review, and diagnosis codes that don't support the regions billed. Each one traces back to a step that can be fixed before the claim is sent.
08
CERT and TPE Audits
Chiropractic claims are subject to CMS's Comprehensive Error Rate Testing (CERT) records requests and to Targeted Probe and Educate (TPE) reviews by Medicare contractors. A records request with a short deadline and thin notes can turn paid claims into overpayments.
How Qualigenix Fixes Each Chiropractic Billing Gap
Qualigenix closes each gap at the step where it opens, before the claim is sent rather than after the denial comes back.
Region-Accurate CMT Coding
Our coders match each CMT code to the regions documented in the note and link every line to a supporting diagnosis. Qualigenix holds 98.9% coding accuracy across all specialties it codes.
Visit-Cap Tracking
We track each patient's approved and used visits by plan and alert your front desk before care runs past an approval, so the next block is requested in time.
AT Modifier Review
Every Medicare manipulation line is checked for the AT modifier and for a note that supports active treatment. When the record points to maintenance care, we flag the visit so an ABN can be issued before treatment.
ABN Management
We track which patients have a valid ABN on file and apply GA, GZ or GY correctly, so non-covered services are billed to the patient the right way.
Benefit Verification
Eligibility, deductibles, visit limits and authorization rules are checked before the first visit and again at each plan-year change.
PART Documentation Checks
Before a Medicare claim is sent, we review the note for PART findings, a treatment plan with measurable goals, and progress that supports continued active care. Missing elements go back to the provider as a specific query, not a general warning.
Denials and Appeals
Denials are worked by root cause, appealed where the record supports payment, and fed back into the coding checks so the same denial doesn't repeat. Qualigenix overturns 79% of the denials it works.
Audit Readiness
When a CERT or TPE request arrives, we pull the records, check them against the billed services and send a complete response before the deadline. Qualigenix holds a 98.6% compliance and audit pass rate.
Claims, Posting, AR and Reporting
Claims go out with an under 24-hour average submission turnaround, payments are posted and matched to the expected rate, and unpaid claims are worked before they age. Reports show collections, denials and visit trends by payer.
CASE STUDY 01
How a 3-provider podiatry group cleared $214K in aged A/R
THE SITUATION
A 3-provider podiatry group with roughly 60% Medicare payer mix carried $412,000 in A/R, 38% of it past 120 days. Routine foot care claims (11720, 11721, 11055–11057) had stalled on inconsistent Q7/Q8/Q9 modifiers and class-finding documentation, so payers held or partially paid and nobody worked the remainder. Medicare crossover to secondaries was not being posted, and small patient balances were written off.
WHAT QUALIGENIX DID
We ran a full A/R aging segmentation, worked claims by payer and denial reason rather than by date, rebilled the stalled routine-care claims with corrected modifiers, and reactivated secondary and crossover billing.
Key Outcomes & Turnaround
38% to 14%A/R past 120 days
$214,000recovered from aged A/R
90 daysto turn it around
~60%Medicare payer mix
Audited Practice Results
How a solo podiatrist lifted first-pass acceptance to 96%
THE SITUATION
A solo podiatrist coding 320 encounters a month was stuck at 82% first-pass acceptance. Routine foot care went out without the systemic-condition diagnosis pairing and class findings Medicare requires, so it read as non-covered. Wound debridement was coded to the wrong depth (11042 for skin and subcutaneous where the note supported 11043 for muscle and fascia). Same-day E/M with a procedure went out without modifier 25 and got bundled.
WHAT QUALIGENIX DID
We rebuilt the coding workflow: diagnosis-to-CPT pairing rules for at-risk foot care, correct Q-modifier logic, depth-based debridement coding tied to the operative note, and disciplined use of modifiers 25 and 59/XS.
Key Outcomes & Turnaround
82% to 96%first-pass acceptance
+11%per-encounter reimbursement
60 daysto turn it around
320/moencounters coded
Audited Practice Results
How a 2-location podiatry practice cut its denial rate by two-thirds
THE SITUATION
A 2-location podiatry practice sat at a 19% denial rate, mostly Medicare routine-foot-care and nail-debridement rejections. The denials clustered in three buckets: medical-necessity rejections on routine foot care (missing qualifying diagnosis and class findings), frequency-edit denials on nail debridement billed inside the 60-day window, and missing Q modifiers that flagged services as non-covered.
WHAT QUALIGENIX DID
We built a front-end denial-prevention layer, checking eligibility and coverage against payer LCDs before claims went out, plus a structured appeal workflow with documentation templates mapped to each denial reason.
Key Outcomes & Turnaround
19% to 6%denial rate
$68,000recovered on appealed claims
4 monthsto turn it around
2 locationspractice size
Audited Practice Results
Chiropractic Coding Matched to the Care You Actually Deliver
Spinal CMT (98940–98942)
Spinal manipulation is the only chiropractic service Medicare covers. The region count drives the code, and every Medicare line for active care carries the AT modifier.
COMPLIANCE
Chiropractic Practices We Support
Solo Chiropractic Practices Multi-Provider Chiropractic Groups Integrated Chiropractic and Rehab Clinics Sports and Wellness Centers Multi-Specialty Musculoskeletal Networks
0%
Audit Pass Rate
<0%
Variance Threshold
Why Chiropractors Choose Qualigenix
Chiropractors choose Qualigenix because it bills chiropractic claims documentation-first, which is where CMS finds nearly all chiropractic payment errors.
0%
Improper payment rate on Medicare chiropractic claims
0%
Share of errors from missing or insufficient documentation
0%
Share of errors from coding
$0M
Medicare chiropractic dollars paid in error
QUESTIONS BUYERS ASK
We add the AT modifier only when the note shows active, corrective treatment of a documented subluxation with measurable goals. When care has become maintenance, Medicare won't pay, so we flag the visit for an ABN instead.
Services other than spinal manipulation are excluded by statute when a chiropractor provides them, so we bill them with the GY modifier and the patient pays. For maintenance care, a signed ABN lets you collect from the patient, and we bill with the GA modifier.
Qualigenix works in 133 EMR and EHR platforms and bills from the system your team already uses. We confirm access and workflow during onboarding.
Qualigenix onboards new practices in 6 days on average. Call 786-259-0231 to set a start date.
Commercial payers may pay a separately identifiable exam with modifier 25 on a manipulation day when the note supports it. Medicare doesn't pay chiropractors for exams, so for Medicare patients the exam is billed as a non-covered service.
We check each Medicare note for two of the four PART findings, with one being asymmetry or range of motion, plus a treatment plan with measurable goals. Missing elements go back to the provider as a specific query before the claim is sent.
Yes. Qualigenix works aging chiropractic AR by payer and age, including personal injury and auto claims, and appeals where the record supports payment. Most practices start with a free AR review.