How to Handle High-Volume Coding in Chiropractic Services

Chiropractic practices often deal with high patient volume and frequent repeat visits—which means high-volume coding is a daily reality. For medical billing licensees, this creates both opportunity and risk: the potential for steady claim volume and the pressure to code with speed and accuracy.

This article outlines how to manage high-volume chiropractic billing efficiently, without sacrificing quality or compliance.

1. Get Familiar with Core Chiropractic Codes

Most chiropractic claims center around a few core CPT codes. The most commonly used include:

• 98940 – Chiropractic manipulation (1–2 spinal regions)

• 98941 – Chiropractic manipulation (3–4 regions)

• 98942 – Chiropractic manipulation (5 regions)

• 98943 – Extraspinal manipulation (e.g., extremities)

Best practice: Build templates or shortcuts in your billing software for these codes to reduce manual entry time.

2. Understand Medical Necessity and Documentation Requirements

Chiropractic services are only reimbursable when deemed medically necessary. This means:

• Documentation must support the diagnosis, treatment plan, and progress.

• Maintenance care (ongoing treatment without new injury or change) is usually not covered by Medicare or commercial plans.

• ICD-10 codes must align with the treatment and region being adjusted.

Best practice: Work closely with providers to ensure every billed visit includes supporting documentation that matches the billed CPT code.

3. Use Proper Modifiers—and Know When They’re Required

Chiropractic billing often involves modifiers that affect reimbursement:

• AT – Acute treatment (required for Medicare)

• GA – Waiver of liability (used when services are likely non-covered)

• GZ – Services expected to be denied, and no ABN was signed

Best practice: Create payer-specific billing rules so modifiers are applied correctly every time, especially for Medicare patients.

4. Streamline Coding for Repeat Visits

Chiropractic care often includes multiple visits per week over several weeks. Manually coding each visit can slow down your workflow and increase the risk of errors.

Best practice: Use billing software or EHR templates to auto-populate repeat visit codes and diagnoses, with built-in prompts to verify ongoing medical necessity.

This speeds up processing while keeping compliance front and center.

5. Watch for Frequency and Utilization Limits

Many payers limit the number of chiropractic visits allowed per year or require pre-authorization after a certain point.

Failing to track these limits leads to denials—even when the coding is correct.

Best practice: Set internal alerts when a patient approaches a payer’s visit limit. If necessary, help the provider initiate pre-authorization or pause billing until it's resolved.

6. Avoid Upcoding or “Code Creep”

In high-volume settings, there’s a temptation to use higher-level codes (like 98941 or 98942) more frequently than documentation supports.

This can trigger audits and repayment demands if patterns suggest upcoding.

Best practice: Regularly audit a sample of claims to ensure coding reflects what’s documented. Pay special attention to consistency in region count and diagnosis-to-treatment alignment.

Efficiently managing high-volume chiropractic coding is about more than speed—it’s about precision, consistency, and proactive safeguards. By knowing the codes, applying modifiers correctly, and working closely with providers on documentation, medical billing licensees can handle volume confidently and protect both revenue and compliance.