Specialties / Chiropractic
Chiropractic billing, done for you
Your chiropractors document the visit. We code it (98940 to 98942 by regions, AT for active care, the right modifier for maintenance care), check it and see it paid. You keep your EMR and see every claim live.
Live for chiropractic practices.
The rules we code and check before a chiropractic claim goes out
Medicare pays a chiropractor for one thing: manual manipulation of the spine to correct a subluxation.
| Rule | What it means | What we check | Who decides |
|---|---|---|---|
| What Medicare pays a chiropractor for | Only manual manipulation of the spine to correct a subluxation. Exams, x-rays and therapies a chiropractor furnishes are not paid by Medicare. Other payers set their own rules. | For Medicare, only 98940 to 98942 go out as covered; other services go out as not covered, or to the payer that covers them | Mohenara codes from your chiropractor's note |
| Codes by spinal regions | 98940 for 1 or 2 regions, 98941 for 3 or 4, 98942 for 5. One code per visit covers every region treated; they are not add-ons. Medicare does not pay 98943 (extraspinal). | The code matches the number of regions the note shows treated, each with its level of subluxation | Mohenara codes from the regions in your chiropractor's note |
| AT for active treatment | Medicare requires AT on 98940 to 98942 for active or corrective treatment of an acute or chronic subluxation. A claim without AT is treated as maintenance and denied. AT alone does not prove the care is necessary. | AT only when the note shows active treatment with expected improvement | Mohenara adds AT when your chiropractor's documentation supports active treatment |
| Maintenance care | Once further improvement is not expected, care is maintenance and Medicare does not pay. With an Advance Beneficiary Notice (ABN) signed before the visit, the claim carries GA and the patient can be billed; without one, GZ and the practice cannot bill the patient. | No AT on maintenance visits; GA only with a signed ABN on file | Your chiropractor decides when care becomes maintenance; your front desk gets the ABN signed; Mohenara codes the modifier |
| Subluxation documented | Shown by an x-ray taken within 12 months before or 3 months after treatment starts, or by a physical exam with 2 of 4 findings (pain, asymmetry, range of motion, tissue tone), one of them asymmetry or range of motion. The primary diagnosis is the subluxation, with its level. | A dated x-ray or the exam findings in the record; the level of subluxation in the diagnosis | Your chiropractor examines and documents; Mohenara checks the record before the claim goes out |
| Dates on the claim | The date of initial treatment, or of the flare-up, goes on every Medicare chiropractic claim. When an x-ray shows the subluxation, its date goes on too. | Initial treatment date present; x-ray date inside the allowed window | Mohenara, from your chiropractor's record |
| Treatment plan and visit notes | A plan with how often and how long, goals and objective measures. Each later visit shows the history, an exam of the treated area, the change since last time and the regions manipulated. Medicare usually pays one manipulation a day. | Plan on file; every visit note signed and listing the regions treated; one manipulation per day | Your chiropractor writes the plan and notes; Mohenara checks before sending |
| Timely filing | Medicare: one calendar year from the date of service. Other payers set their own. | Each payer's deadline tracked; aging claims worked before it | Mohenara |
Medicare contractors publish local rules for chiropractic care; we check the ones for your state.
Before the visit
Software
Automated check
- Coverage active, plan dates, copay, coinsurance and deductible, as the insurance company returns them.
- Chiropractic visit limits and visits used this year, where the plan reports them.
- An answer the payer leaves incomplete stays unknown, never zero.
Software
Tracking
- Visits used against visits approved, and authorization end dates.
You
Your front desk
- Fixes insurance cards and details in your EMR.
- Requests authorizations.
- Gets an Advance Beneficiary Notice (ABN) signed before a Medicare maintenance visit.
- Collects copays.
A coverage check is not a guarantee of payment.
What you see in your dashboard
Every adjustment claim as it moves: sent, paid, denied or waiting on you, and the money in your bank.
Your dashboard, Money: collected, in your bank and owed, live.See every view of your dashboard
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