MedFactor Inc. partners with chiropractic practices nationwide to deliver specialty revenue cycle management, certified coding, and proactive denial prevention. Keep your focus on patient care while we maximize every claim you submit.
MedFactor Inc. delivers consistent performance across solo clinics, multi-location groups, and specialty chiropractic centers.
Every chiropractic niche carries its own billing complexity. Our certified team adapts to the documentation, payer rules, and coding requirements unique to your practice.
Full scope manipulative treatment billing for solo and group practices. We manage CMT codes 98940, 98941, and 98942 with strict attention to AT modifier compliance, regional designation, and Medicare active treatment documentation.
Billing for athletic injury care, rehabilitation, and return to play protocols. We handle therapy modifiers, timed codes, and sports medicine documentation that commercial payers and PPO plans require for approval.
Age specific documentation, pediatric ICD-10 codes, and guardian consent handling. We navigate Medicaid and commercial pediatric plans with careful attention to developmental diagnosis requirements.
Mixed patient demographics require flexible coding and eligibility verification. We manage multi payer billing, family plan coordination, and the documentation differences between active and maintenance care.
Integrated rehab centers billing therapeutic exercise, manual therapy, and modalities alongside CMT. We handle therapy caps, KX modifiers, and 8 minute rule timing with precision.
Auto accident billing involves PIP coverage, letters of protection, and third party liability. We manage the unique paperwork, state specific forms, and payer coordination required for motor vehicle claims.
PI cases demand meticulous SOAP notes, causation documentation, and lien tracking. We support attorneys and clinics with detailed billing packets, records release, and settlement reconciliation.
Wellness and maintenance care often fall outside insurance coverage. We help practices structure cash pay programs, superbills, and proper documentation to avoid audit exposure when billing maintenance visits.
Workers comp billing requires state specific forms, preauthorization, and fee schedule compliance. We manage the entire lifecycle from first report of injury through claim closure and dispute resolution.
Multi discipline centers billing chiropractic, physical therapy, massage, and acupuncture face complex bundling rules. We coordinate NCCI edits, modifier usage, and payer specific policies across services.
Chiropractic billing is one of the most audit sensitive specialties in healthcare. Our team anticipates these issues before they impact your revenue.
CMT codes 98940, 98941, and 98942 require precise spinal region documentation. Missing regional designation or incorrect vertebral count triggers automatic denials from most major payers.
Medicare and many commercial plans do not cover maintenance care. Clear documentation of active treatment with measurable improvement is required to avoid retroactive denials and patient liability issues.
Medicare requires the AT modifier, a treatment plan with measurable goals, and regular re evaluations. Practices that miss any element face claim rejection or post payment recoupment.
The AT modifier identifies acute chiropractic care. Using it incorrectly on maintenance visits or omitting it on active treatment creates audit exposure and claim delays across all Medicare MACs.
Subjective, Objective, Assessment, and Plan notes must support medical necessity for every visit. Weak SOAP notes are the leading cause of chiropractic audit failures and claim reversals.
Each state has different WC forms, fee schedules, and authorization rules. Late filing, missing forms, or incorrect procedure codes delay payment by months and create unnecessary disputes.
PI billing requires causation documentation, lien tracking, and coordination with attorneys. Most billing teams lack the specialized knowledge to handle these cases without leaving revenue on the table.
PIP coverage limits, state specific forms, and third party liability create layers of complexity. One missing form or incorrect box can delay payment for months or result in full denial.
Payers increasingly require objective findings, functional outcome measures, and documented progress to approve continued care. Without these, claims are denied as not medically necessary.
Therapy codes have annual thresholds and visit limits. Tracking these across payers requires dedicated oversight to prevent surprise denials mid treatment plan.
Each commercial payer writes its own chiropractic policy. Visit limits, documentation expectations, and modifier rules vary widely and change frequently.
Many plans cap chiropractic visits per year or per condition. Without proactive tracking, practices deliver care that will never be reimbursed, creating bad debt and patient friction.
Our billing consultants identify patterns across hundreds of chiropractic accounts. These insights drive the strategies we apply to your practice.
Capture every billable service through complete code selection, proper modifier use, and timely filing. Most chiropractic practices leave significant revenue uncaptured each month due to preventable process gaps.
Strong SOAP notes, clear treatment plans, and measurable outcomes are the foundation of every paid claim. We coach providers on documentation that satisfies auditors and payers alike.
Most denials are preventable with front end edits, eligibility verification, and coding review before claim submission. We build these checks into every claim we submit.
Contract variance analysis reveals when payers reimburse below contracted rates. We identify, appeal, and recover these underpayments to protect your bottom line.
Click any denial category to see why it happens, what it costs your practice, and how MedFactor Inc. prevents it from recurring.
The AT modifier identifies acute chiropractic care. Staff often omit it or apply it to maintenance visits.
Medicare and many commercial payers deny claims without the AT modifier, delaying payment and creating audit risk.
Automated claim edits verify the AT modifier is present on every CMT claim before submission.
Our team reviews every chiropractic claim for modifier accuracy and documents active treatment status in the claim notes.
Documentation shows no measurable improvement or the visit frequency no longer matches an active treatment plan.
Payers deny the claim and may shift liability to the patient without proper ABN or waiver documentation.
Clear documentation of active treatment goals, objective progress, and regular re evaluations.
We audit treatment plans, flag maintenance patterns, and secure proper patient financial responsibility documentation in advance.
SOAP notes lack objective findings, regional specificity, or clear medical necessity language.
Post payment audits can recoup months of revenue when documentation does not support the billed service.
Standardized templates, provider training, and real time documentation review.
Our auditors review charts weekly and coach providers on the documentation elements each payer requires.
The diagnosis does not support the procedure, or visit frequency exceeds what the payer considers reasonable.
Claims denied as not medically necessary are difficult to overturn without strong clinical documentation.
ICD-10 and CPT alignment review before submission, with visit frequency tracking against payer policies.
We maintain a payer policy library and apply medical necessity edits at the claim level to prevent denials before they occur.
Incorrect use of modifiers 25, 59, 76, 77, GP, GA, or GY triggers bundling denials or compliance flags.
Claims are rejected or paid at reduced rates, and incorrect modifiers invite audit scrutiny.
NCCI edit checks and modifier decision trees applied by certified coders.
Every claim passes through AAPC certified chiropractic coders who verify modifier logic before submission.
Claims sit in queue too long or are rejected and rebilled after the filing deadline passes.
Timely filing denials are almost never recoverable, creating pure revenue loss.
Daily claim submission, automated filing deadline tracking, and rejection work queues.
We submit claims within 48 hours of service and track every payer specific filing limit to protect your revenue.
Re submission of a claim without proper documentation of a prior rejection, or billing the same service twice.
Duplicate claims are denied and can trigger compliance reviews with the payer.
Claim scrubbing and duplicate detection logic before submission.
Our clearinghouse edits catch duplicates and our team documents prior denial reasons before resubmitting any claim.
Wrong CPT level, incorrect spinal region, or mismatched ICD-10 codes.
Under coding leaves revenue on the table. Over coding creates audit and refund risk.
Certified coders review every encounter against documentation before claim submission.
AAPC certified chiropractic coders audit 100 percent of claims for accuracy and compliance.
The diagnosis does not logically support the procedure billed, or the code combination is inconsistent with payer policy.
Automatic denial with no path to appeal without documentation changes.
Diagnosis to procedure crosswalks maintained for every payer and updated quarterly.
We maintain chiropractic specific code crosswalks and flag mismatches before the claim leaves the office.
Services rendered without required authorization, or authorization obtained for the wrong code or date range.
Most payers will not retroactively authorize, resulting in full claim denial.
Front end eligibility and authorization checks before every visit.
We verify benefits and secure authorizations in advance, tracking visit counts against approved limits.
A quick reference for the CPT codes, ICD-10 diagnoses, and modifiers our team uses every day to keep chiropractic claims clean and compliant.
| CPT | Procedure | Typical Use | Billing Notes |
|---|---|---|---|
| 98940 | Chiropractic manipulative treatment, 1 to 2 spinal regions | Single region adjustment such as cervical or lumbar | Requires AT modifier for active care. Document spinal region and vertebral levels. |
| 98941 | Chiropractic manipulative treatment, 3 to 4 spinal regions | Multi region treatment in a single encounter | Document each region treated. Do not bill with 98940 for the same date. |
| 98942 | Chiropractic manipulative treatment, 5 or more spinal regions | Extensive multi region treatment | Rarely used. Requires clear documentation of all five regions. |
| 97010 | Hot or cold packs | Modalities adjunct to CMT | Many payers bundle this with E/M or CMT. Check payer policy. |
| 97012 | Traction | Mechanical or manual traction | Document time, type, and region. Often requires authorization. |
| 97014 | Electrical stimulation, unattended | eStim applied during visit | Time based. Document total minutes and medical necessity. |
| 97032 | Electrical stimulation, attended (manual) | Attended eStim requiring constant provider attention | Time based in 15 minute increments. Document start and stop times. |
| 97035 | Ultrasound therapy | Therapeutic ultrasound | Time based. Document area treated and parameters. |
| 97036 | Contrast baths | Alternating hot and cold therapy | Time based. Less commonly covered. |
| 97110 | Therapeutic exercise | Range of motion, strengthening, stabilization | Time based. Requires direct patient contact documentation. |
| 97124 | Massage therapy | Myofascial release, soft tissue work | Time based. Document technique and area. |
| 97140 | Manual therapy | Joint mobilization, manipulation, soft tissue techniques | Time based. Often requires modifier 59 when billed with CMT. |
| 97116 | Gait training | Walking training including stair climbing | Time based. Document functional goals. |
| 99201-99215 | Evaluation and Management | New or established patient office visits | Modifier 25 required when billed with CMT on same date. |
| ICD-10 | Diagnosis | Clinical Use | Documentation Notes |
|---|---|---|---|
| M54.2 | Cervicalgia | Neck pain without radiculopathy | Document onset, aggravating factors, and functional limitation. |
| M54.12 | Cervical radiculopathy | Neck pain with nerve root involvement | Include dermatomal findings and neurologic exam results. |
| M54.5 | Low back pain | Lumbago or nonspecific low back pain | Most common chiropractic diagnosis. Document region and severity. |
| M54.16 | Lumbosacral radiculopathy | Low back pain with radicular symptoms | Document straight leg raise, reflex changes, and motor findings. |
| M54.6 | Pain in thoracic spine | Mid back pain | Specify location and any associated rib or postural findings. |
| M54.17 | Radiculopathy, sacral and sacrococcygeal region | Sacral nerve root symptoms | Document neurologic findings specific to sacral distribution. |
| M99.01 | Segmental and somatic dysfunction, cervical region | Segmental dysfunction, cervical | Support with objective findings of joint restriction. |
| M99.02 | Segmental and somatic dysfunction, thoracic region | Segmental dysfunction, thoracic | Document regional palpation and motion findings. |
| M99.03 | Segmental and somatic dysfunction, lumbar region | Segmental dysfunction, lumbar | Most common somatic dysfunction code for chiropractic. |
| M99.04 | Segmental and somatic dysfunction, sacral region | Segmental dysfunction, sacral | Document pelvic findings and related symptoms. |
| S13.4xx | Sprain of cervical spine | Acute cervical sprain | Use for acute injury. Include 7th character for encounter type. |
| S33.5xx | Sprain of lumbar spine | Acute lumbar sprain | Common for auto and work injuries. Document mechanism. |
| M47.816 | Spondylosis without myelopathy, lumbar region | Degenerative changes, lumbar | Support with imaging findings when available. |
| G44.209 | Tension headache, unspecified | Cervicogenic or tension type headache | Link to cervical findings for chiropractic medical necessity. |
| Modifier | Description | When Used | Common Denial Risk |
|---|---|---|---|
| AT | Acute treatment | Required on CMT for Medicare and many commercial payers to identify active care | |
| GA | Waiver of liability issued | Used when provider expects denial and patient has signed ABN | |
| GY | Item or service not covered | Used for services statutorily excluded or not a benefit | |
| GP | Services delivered under outpatient therapy plan | Therapy services delivered under a plan of care | |
| 25 | Significant, separately identifiable E/M service | E/M visit on same day as CMT or other procedure | |
| 59 | Distinct procedural service | Separate procedure distinct from other services on same date | |
| 76 | Repeat procedure by same physician | Same procedure repeated on same date by same provider | |
| 77 | Repeat procedure by another physician | Same procedure repeated by different provider on same date | |
| XS | Separate structure | More specific version of modifier 59 for distinct anatomical site | |
| KX | Thresholds exceeded, medical necessity documented | Therapy services above annual threshold |
Our team manages prior authorization across every payer and service type, so your providers can focus on patient care instead of fax machines.
X-ray, MRI, and CT authorization with clinical justification, peer to peer support, and payer specific form completion.
Therapy visit authorization with treatment plan submission, visit count tracking, and renewal management before expiration.
Multi visit rehab plan authorization with functional outcome measures, progress reporting, and continued stay justification.
State specific WC authorization with form completion, adjuster coordination, and treatment plan approval tracking.
We track each commercial payer's chiropractic authorization policy, visit limits, and documentation requirements in a centralized system.
Proactive tracking of authorization expiration dates with timely renewal submissions to prevent gaps in coverage.
Most practices lose 15 to 30 percent of expected revenue to preventable leakage. We find it, stop it, and recover what has already been lost.
Missing SOAP elements, unsigned notes, and incomplete treatment plans create unbillable encounters.
AT, 25, 59, GP, and KX modifiers are frequently omitted, triggering preventable denials.
Visits billed as active care without documentation support are denied and create patient balance issues.
Payers reimbursing below contracted rates go unnoticed without regular contract variance analysis.
Under coding leaves revenue uncaptured. Over coding creates audit exposure and refund liability.
Denials sitting in queues without follow up become write offs within 90 days.
Outdated eligibility, incorrect plan codes, and missed coordination of benefits create front end denials.
Claims submitted after payer deadlines are pure revenue loss with no appeal path.
End to end revenue cycle management built specifically for chiropractic practices. Every service integrates with your existing workflow and EHR.
Real time eligibility verification before every visit, including benefit details, copays, deductibles, and visit limits.
Detailed benefit breakdowns for chiropractic, therapy, and ancillary services with patient responsibility estimates.
Complete prior auth management for imaging, therapy, and extended treatment plans with renewal tracking.
AAPC certified chiropractic coders review every encounter for accurate CPT, ICD-10, and modifier selection.
Electronic claim submission within 48 hours of service with scrubbing, editing, and real time acceptance tracking.
Root cause analysis, timely appeal submission, and payer follow up until every collectible dollar is recovered.
Active A/R follow up, payer call resolution, and aging bucket management to keep cash flow healthy.
ERA and EOB posting with contract variance analysis, underpayment detection, and patient statement generation.
Custom dashboards with KPIs, denial trends, payer performance, and revenue forecasts delivered monthly.
Get in network faster and stay enrolled without interruption. Our credentialing specialists handle every payer, every state, and every revalidation.
PECOS enrollment, MAC coordination, and revalidation management.
State specific Medicaid enrollment with ongoing compliance monitoring.
Panel applications across all major commercial payers and regional plans.
Complete CAQH profile setup, attestation, and ongoing maintenance.
State WC network enrollment with fee schedule and form compliance.
General billing companies miss the nuances that make or break chiropractic revenue. Our team lives and breathes chiropractic coding every day.
Spinal region documentation, vertebral level specificity, and correct code selection require chiropractic specific training that general billers lack.
AT, 25, 59, GP, and KX modifiers each have specific rules. Incorrect use triggers denials and audit exposure.
SOAP notes must meet payer specific requirements for active treatment, medical necessity, and functional progress.
Medicare chiropractic rules are unique. Only specialty teams consistently navigate AT modifier, treatment plan, and re evaluation requirements.
PI billing requires lien management, causation documentation, and attorney coordination that general billers do not offer.
State specific WC rules, forms, and fee schedules require dedicated expertise to avoid months of payment delays.
Chiropractic medical necessity is payer specific and evolving. Our team tracks policy changes and applies them proactively.
MedFactor Inc. has built every workflow, template, and training program around the unique needs of chiropractic practices. Our team includes certified chiropractic coders, former practice managers, and revenue cycle specialists who understand your world.
From the moment a patient schedules to the final dollar collected, every step is managed with precision and accountability.
Real time insurance verification before the patient arrives, with benefit details shared with front desk staff.
Patient check in with copay collection, followed by provider documentation support and template guidance.
Certified coders review every encounter, assign CPT and ICD-10 codes, and apply appropriate modifiers.
Every claim passes through chiropractic specific edits before submission to catch errors and prevent denials.
Electronic submission within 48 hours with real time acceptance tracking and rejection management.
ERA and EOB posting with contract variance analysis and underpayment detection.
Root cause analysis, timely appeals, and payer follow up until every collectible dollar is recovered.
Monthly performance reports with actionable insights to continuously improve your revenue cycle.
See how outsourcing to MedFactor Inc. compares to managing billing in house across every dimension that matters to your practice.
| Capability | In House Team | MedFactor Inc. |
|---|---|---|
| Chiropractic Coding Expertise | Limited | AAPC Certified Specialists |
| AT Modifier Compliance | Inconsistent | Automated and Audited |
| Denial Prevention | Reactive | Proactive Claim Edits |
| Payer Policy Knowledge | Varies by Staff | Centralized and Updated |
| Coverage During Absences | Gaps in Coverage | Uninterrupted Service |
| Technology and Reporting | Basic Tools | Advanced Dashboards |
| Cost Predictability | Variable with Overhead | Fixed Percentage Pricing |
| Scalability | Limited by Staff | Unlimited Capacity |
| Compliance Monitoring | Self Audited | Continuous Compliance |
| Time to Value | Months of Training | 30 Day Onboarding |
Our team reviews your current billing performance and identifies the revenue opportunities hiding in your claims, denials, and contracts.
Speak with a chiropractic billing specialist. No obligation, no pressure. Just clarity on where your revenue is leaking and how to fix it.
Schedule My AssessmentEvery practice is different, but the outcomes follow a consistent pattern once specialty billing expertise is applied.
A solo chiropractor was spending 15 hours per week on billing with declining collections and rising denials. After onboarding with MedFactor Inc., the provider reclaimed clinical time while collections improved and denials dropped significantly within the first quarter.
A growing multi location group struggled with inconsistent billing across sites, rising A/R, and payer contract leakage. MedFactor Inc. standardized workflows, implemented centralized denial management, and recovered significant underpayments across all locations.
A sports chiropractic center billing therapy, CMT, and rehabilitation services faced bundling denials, therapy cap issues, and authorization gaps. Our team restructured their coding, implemented therapy tracking, and built a prior authorization workflow that eliminated most preventable denials.
MedFactor Inc. supports chiropractic practices in every state with deep expertise in Medicare, Medicaid, commercial insurance, and specialty payer programs.
Deep knowledge of every MAC, AT modifier rules, and chiropractic coverage policies nationwide.
State specific Medicaid billing rules, enrollment, and compliance across all 50 states.
Every major commercial payer and regional plan, with policy libraries updated continuously.
HIPAA compliant workflows, OIG guidance adherence, and regular compliance training for every team member.
Answers to the questions chiropractic providers ask most often about billing, coding, credentialing, and working with MedFactor Inc.
Partner with MedFactor Inc. and experience the difference specialty chiropractic billing expertise makes. Schedule your free assessment today and discover the revenue waiting in your practice.