1. Covered vs. Non-Covered Services
✔ Medicare only covers spinal manipulation for subluxation treatment
✔ Exams, x-rays, massage, and maintenance therapy are typically not covered
✔ Commercial plans may offer broader coverage—verify benefits before each visit
2. Accurate Coding for Chiropractic Services
✔ Use CPT codes 98940–98942 based on the number of spinal regions treated
✔ Pair with ICD-10 subluxation codes (e.g., M99 series)
✔ Apply AT modifier for active treatment; use GA, GY for non-covered services
3. Documentation Requirements
✔ Include initial exam findings, diagnosis, and treatment plan
✔ Record progress notes for each visit with measurable goals
✔ Update medical necessity regularly to support ongoing care
4. Medicare-Specific Rules
✔ Submit claims using the AT modifier for covered services
✔ Maintenance therapy must be clearly labeled and billed as non-covered
✔ Re-certify care plans if treatment extends beyond expected duration
5. Common Challenges & Fixes
| Challenge | Fix |
| Denials for lack of medical necessity | Include clear diagnosis and progress documentation |
| Incorrect use of modifiers | Train staff on proper AT, GA, and GY usage |
| Patient confusion over non-covered services | Use ABN forms and explain out-of-pocket costs |
| Billing massage or rehab under manipulation | Separate codes and services clearly in claim submission |
