Best Practices for Chiropractic Billing and Coding in 2026

Accurate chiropractic billing and coding are essential for clean claims, timely reimbursement, and compliance. In 2026, chiropractic practices should pay close attention to current CPT and ICD-10-CM requirements, payer policies, documentation, and medical necessity. For Medicare claims in particular, documentation remains a major concern: CMS reported a 33.6% improper payment rate for chiropractic services for the 2024 reporting period, with insufficient documentation accounting for 95.5% of improper payments.

Verify Current Coding Requirements

One of the most important chiropractic billing best practices is to use the code set applicable to the date of service. CPT and ICD-10-CM codes can be revised, so practices should avoid relying on outdated code lists or previously submitted claims. CMS provides current coding resources and 2026 ICD-10-CM files for applicable encounters.

Before submitting a claim, coders should verify that the procedure code, diagnosis code, modifier, and payer requirements accurately reflect the services documented in the patient’s record.

Use the Correct Chiropractic Procedure Codes

For Medicare, chiropractic manipulation claims commonly involve CPT codes 98940, 98941, and 98942, which correspond to spinal manipulation involving one to two, three to four, or five spinal regions. CMS guidance specifically addresses these codes and their documentation requirements.

Practices should select the appropriate code based on the documented service rather than automatically using the same code for every visit.

Pay Attention to the AT Modifier

The AT modifier is particularly important for Medicare chiropractic billing. CMS states that it should be used with CPT codes 98940, 98941, and 98942 when the service represents active or corrective treatment for acute or chronic subluxation. It should not be appended when the service is maintenance therapy.

Simply adding the AT modifier does not establish medical necessity. The clinical documentation must still support the treatment provided.

Strengthen Documentation

Complete documentation should support the patient’s condition, treatment plan, services performed, and medical necessity. CMS guidance indicates that chiropractic records should document relevant history, examination findings, diagnostic information when applicable, treatment goals, and progress.

For Medicare chiropractic claims, providers should also document the precise spinal location and level of subluxation when required, along with the initial treatment date or date of exacerbation.

Strong documentation gives coders the information they need to assign accurate codes and gives payers evidence supporting the claim.

Match Diagnoses to the Services Provided

Diagnosis coding should accurately describe the condition for which the chiropractic service was performed. CMS guidance requires the diagnosis code to best describe the patient’s condition and notes that claims must contain a valid ICD-10-CM diagnosis code.

Coders should avoid selecting diagnosis codes simply because they were used on previous claims. Each claim should be supported by the patient’s current documentation.

Final Thoughts

A pre-submission review can help identify common errors such as missing modifiers, incorrect diagnosis codes, incomplete documentation, mismatched procedure and diagnosis information, or missing required claim details.

Practices can also use medical billing services to support claim preparation, coding review, and reimbursement processes.

Denial analysis can reveal recurring problems within a chiropractic practice. Categorizing denials by coding errors, documentation issues, eligibility, authorization, medical necessity, and payer-specific requirements can help identify patterns.

Using denial management services can help practices organize follow-up and address preventable claim issues. A broader revenue cycle management strategy can also connect coding, billing, collections, and payment follow-up.