SpecialtiesTherapy & rehabilitation
How we see chiropractic billing.
Reviewed by the VisMed therapy & rehabilitation billing team
Medicare covers spinal manipulation for active treatment of a documented subluxation and nothing else a chiropractor does. The modifier that attests to active treatment has to be on the claim, the documentation has to show the subluxation and the treatment plan, and when care becomes maintenance it must be billed as non-covered with the patient informed. Medicare audits chiropractic claims heavily and finds documentation failures in a large share of them.
Commercial plans cover more, including examinations, therapies and sometimes extremity manipulation, under visit limits and authorization requirements that vary by plan. Personal injury and workers’ compensation add their own forms and timelines.
VisMed runs a Medicare compliance workflow that separates active treatment from maintenance, gives your clinicians documentation templates that meet the subluxation and plan requirements, and holds each commercial plan’s coverage and limits separately.
Where chiropractic practices lose money
The patterns we find in the aging and denial history before anything else changes.
Active-treatment modifier and maintenance
Claims without the active-treatment modifier are denied; claims with it during maintenance care are recoupments. The transition has to be identified and documented.Subluxation documentation
Medicare requires the subluxation to be documented by examination or imaging, with the treatment plan and goals. Notes that lack it fail audit.Region counts
Manipulation codes step by spinal regions treated, each needing a documented diagnosis. Mismatches are denials.Non-covered services billed to Medicare
Examinations, therapies and supplies are not covered. Billing them, or not giving the required notice before charging the patient, is a compliance failure.Commercial visit limits and authorizations
Plans cap visits and some require authorization after a number. Visits beyond them are unpaid.
What we do differently for chiropractic
Specialty-matched coders and a denials specialist, working inside your own system.
We run a Medicare compliance workflow
Active treatment versus maintenance is decided and documented per episode with your clinician, the modifier is applied accordingly, and we issue the patient notice when care becomes maintenance.We give you documentation templates
Subluxation findings, diagnoses by region, treatment plan and goals are captured in a structure that meets audit requirements.We hold commercial rules per plan
Coverage, visit limits and authorization thresholds are held per plan and tracked per patient.We keep non-covered services off Medicare claims
Non-covered services are charged to the patient with notices in your system, never on a Medicare claim.
What we bill
The procedure and code families your account team already works in.
Chiropractic billing, asked and answered.
What a physician-owner in this specialty asks on the first call.
When does care become maintenance under Medicare?
When continued treatment is not expected to produce further improvement and is aimed at maintaining the current state. Medicare will not pay for it. VisMed identifies the transition with your clinician from the plan and progress, documents it, drops the active-treatment modifier and issues the patient notice so the patient can be charged.
What does Medicare need in the note?
A documented subluxation by examination or imaging, the regions and diagnoses, a treatment plan with goals and frequency, and progress against it. VisMed’s templates capture those elements without adding time to the visit.
Can we bill examinations and therapies?
To commercial plans that cover them, yes, under their rules and visit limits. To Medicare, no, and VisMed charges them to the patient with the appropriate notice.
Does VisMed handle personal injury claims?
Yes, as a separate lane with liens, attorney correspondence and the documentation those cases require, kept apart from health-plan billing.
How does VisMed reduce our Medicare audit exposure?
By making every Medicare claim match a note that carries the subluxation, the regions, the plan and the progress, and by taking claims off Medicare the moment care becomes maintenance. Our quarterly review reads a sample of notes against exactly what an auditor would look for.
Also in therapy & rehabilitation
Physical therapy
Timed units, KX modifiers and progress notes.
Occupational therapy
Plan-of-care certification and caps.
Speech therapy
Evaluation vs treatment, pediatric Medicaid.
ABA therapy
Adaptive-behavior codes, authorization units and BCBA supervision.
Podiatry
Routine foot-care exceptions and DME.
All specialties
The full list, in six groups
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