What insurers expect on a chiropractic superbill
A chiropractic superbill has to tell a reviewer three things: which spinal regions you adjusted, why each region needed treatment, and whether any other service that day was truly separate from the adjustment. Insurers check that the manipulation code matches the number of regions, that each region has a supporting diagnosis, and that exams and therapies are not simply part of the adjustment billed twice.
The usual provider and patient details apply too: your name and DC credentials, license number, individual NPI and Tax ID, the patient’s insurance carrier and member ID, and a date, place of service, diagnosis pointer, units and fee on every line.
Chiropractic codes at a glance
| Code | When to use it |
|---|---|
| 98940 | Spinal adjustment of one or two regions |
| 98941 | Spinal adjustment of three or four regions |
| 98942 | Spinal adjustment of all five regions |
| 98943 | Extraspinal adjustment, such as a shoulder, knee or TMJ |
| 99203 | New patient exam with history and decision making beyond the adjustment |
| 99212 / 99213 | Re-examination of an established patient, or evaluation of a new complaint |
| 97140 | Hands-on manual therapy on a different region from the adjustment, in 15-minute units |
| 97110 / 97112 | Active exercise or neuromuscular retraining, in 15-minute units |
| 97124 / 97035 | Massage or ultrasound, in 15-minute units |
| 97012 | Mechanical traction, one unit per visit |
| 97014 or G0283 | Unattended electrical stimulation, one unit per visit; Medicare and some plans use G0283 |
| 72100 | Lumbosacral X-ray, 2 or 3 views, when taken in your office |
Counting spinal regions
For the spinal codes, CPT recognizes five spinal regions: cervical (including the atlanto-occipital joint), thoracic (including the rib joints at the spine), lumbar, sacral, and pelvic (the sacroiliac joint). Adjusting C5 and C6 is still one region. The extraspinal regions for 98943 are the head (including the TMJ), the lower extremities, the upper extremities, the rib cage away from the spine, and the abdomen; one 98943 line covers any number of them.
A simple check before printing: count the different spinal-region diagnoses you point to on the CMT line. In the sample, the cervical and lumbar segmental dysfunction codes support two regions, so the adjustment is 98940.
Timed and untimed services
Exercise, manual therapy, massage and ultrasound are billed in 15-minute units of one-on-one time. Under Medicare’s 8-minute rule, you add up all timed minutes in the visit and convert the total, so 8 to 22 minutes is one unit and 23 to 37 minutes is two. Commercial plans may count each code on its own instead, so check the patient’s plan. Traction and unattended electrical stimulation are supervised services billed as one unit regardless of length. In the sample, about 25 minutes of exercise appears as 97110 with two units.
Modifiers chiropractors use
- 25 goes on the exam, not the adjustment, when the exam is significant and separate, such as an initial exam or a re-exam for a new injury.
- 59 (or XS, if the payer prefers it) tells the payer that 97140 was done on a different region from the adjustment. Without it, many plans bundle manual therapy into the CMT code.
- AT, GA and GY are Medicare modifiers. AT marks active or corrective manipulation, GA shows a required advance beneficiary notice is on file, and GY flags a service Medicare excludes, such as an exam or therapy performed by a chiropractor. Commercial plans generally do not need them.
- GP is required by some commercial plans on therapy codes even when a chiropractor provides them.
Chiropractic-specific gotchas
- Medicare patients. Chiropractors cannot opt out of Medicare, so Medicare beneficiaries generally need you to file covered adjustments as a claim rather than receive a superbill.
- Maintenance care. Once a patient stops improving, many plans treat further visits as maintenance and stop reimbursing. Re-exams that document progress help show when care is still active.
- Visit limits. Many plans cap chiropractic visits per year or require a referral or authorization after a set number. Coverage varies by plan.
- Injury coding. For sprains, the “A” seventh character signals active treatment. Use the subsequent-encounter version once the patient is in the healing phase.
- Region documentation. Medicare requires the subluxation to be shown by X-ray or by exam findings, and commercial reviewers expect each billed region to appear in your notes.
How to fill this chiropractic superbill template
- Clinic details. Enter the practice name, your name, DC credentials, license number, address, phone, email, NPI and Tax ID. The NPI field checks the check digit.
- Patient details. Add name, date of birth, address, insurance carrier, member ID and group number.
- Diagnoses. List a segmental dysfunction code for each region you adjust, then the pain, sprain or radiculopathy codes that explain why. Up to 12 codes fit, lettered A to L.
- Visit lines. Add the exam (with modifier 25 when it qualifies), then the CMT line, then any therapy. Use units for timed codes.
- Pointers. Point the CMT line to the region diagnoses and therapy lines to the condition they treat.
- Finish. Enter the amount paid, type your signature, check the list of missing fields, and Print / Save as PDF.
Build your superbill
Load the sample to see a completed chiropractic superbill, then add your own details in the generator above. Patients new to filing can read how to submit a superbill to insurance, and the HSA and FSA guide helps those paying from a health account. To see how a superbill relates to a full claim form, read superbill vs CMS-1500. Clinics that also offer rehab or acupuncture can use the physical therapy and acupuncture templates.