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- info@a2zbillings.com
Primary care billing crosses more code families in a single week than most specialties see in a year. We keep each one accurate, so a full schedule turns into a full deposit.
Covered CMT codes
98940
98941
98942
AT
M9.0x
Chiropractic practices work under some of the narrowest coverage rules in the Medicare program. Its only benefit is for manual manipulation of the spine to correct a subluxation, which includes the exams, X-rays, and therapy modalities that fill a normal treatment day fall outside what Medicare pays a doctor of chiropractic. When those details are handled loosely, money the practice legitimately earned gets denied at submission or recouped later after an audit.
Chiropractic billing is mostly about defending each adjustment rather than the volume of claims: coding it to the correct number of spinal regions, tying it to a documented subluxation, and building a record that holds up when a Medicare contractor asks to see it. A2Z Billings manages that work for chiropractic offices across the United States, so clinical time stays clinical and the claim side stays clean.
The CMT family is billed by region: 98940 covers one to two spinal regions, 98941 covers three to four, and 98942 covers five. The extraspinal code 98943 is statutorily non-covered by Medicare. The count has to match what the note describes.
Medicare pays for corrective care expected to improve function. Once treatment turns preventive it becomes maintenance therapy and is no longer payable, even for the same patient and the same adjustment. Billing has to reflect that visit by visit.
A practice often runs high daily patient counts at a modest per-visit allowance. A small denial percentage repeated across hundreds of visits pulls real dollars out of the month, so claims have to leave the office correct the first time.
None of these are complicated on their own. What makes them expensive is how often they repeat across a full patient panel, one small denial at a time.
The two-business-day contact and the required face-to-face visit both have a clock attached. Once either deadline passes, the entire TCM claim is gone, not reduced.
Falling one day short of the required transmission days turns a full month of monitoring into a month with nothing to bill.
These codes are paid on a running total of minutes. Without a log tied to the calendar, there is no number to submit.
Billing the encounter under the wrong clinician, or without documentation of who did the substantive work, invites a takeback even when the care itself was appropriate.
The wrong POS code or a missing modifier on a virtual visit can change the allowed amount, sometimes down to nothing.
ACP billed without the minutes and content of the discussion reads to a payer as a conversation that never happened.
Every one of these programs pays for something specific: a phone call inside a window, a set number of monitoring days, a logged conversation. The documentation has to show that exact thing happened, not that care was provided in general.
| Code | Regions | Medicare |
|---|---|---|
| 98940 | 1–2 spinal | Covered |
| 98941 | 3–4 spinal | Covered |
| 98942 | 5 spinal | Covered |
| 98943 | Extraspinal | Non-covered |
| M99.0x | Segmental & somatic dysfunction — primary, matched to region |
| M54 | Dorsalgia, cervicalgia, sciatica — secondary |
| M50 / M51 | Cervical, thoracic, and lumbar disc disorders |
| S13 / S23 / S33 | Spinal sprains and strains when injury applies |
Initial visits record the chief complaint and history, PART findings, the exact subluxation level, and a treatment plan with goals, frequency, and expected improvement. Subsequent visits record the updated complaint, current findings, the response to prior care, and the treatment performed. For non-covered and maintenance services, the correct instrument is the current ABN, form CMS-R-131.
Two patients on the same insurance company can carry different plans with different referral, authorization, and coverage rules. Primary care sees this variation constantly, since it sits at the front of almost every patient's care.
Referral requirements, prior authorization, and network rules can differ from plan to plan under the same carrier, and they rarely match traditional Medicare for the same CPT code.
Coverage for services like remote monitoring, behavioral health integration, or telehealth can depend on the specific state Medicaid plan, and documentation that satisfies one plan may not satisfy another.
Confirming remaining deductible, copay, and any authorization requirement before the patient arrives keeps the bill accurate and cuts down on collections work afterward.
Confirm the chiropractic benefit, visit caps, deductible status, and authorization needs up front.
Catch a missing PART element or absent secondary diagnosis while it can still be corrected.
Region-matched CMT code, the right modifier, and paired diagnoses that align with the note.
Separate true maintenance denials from fixable gaps, appeal what should be paid, and keep AR days low.
Reconcile the Medicare 80%, patient coinsurance, and self-pay maintenance so balances stay accurate.
We handle billing, coding, revenue cycle management, credentialing, prior authorization, and denial recovery, set up around the programs family medicine runs day to day rather than a generic template.
Denials are worked as specific disputes. A maintenance denial the record can overturn is appealed; a genuinely non-covered service is routed to the ABN and patient responsibility instead of being written off. A2Z Billings supports chiropractic providers across the United States, from solo practitioners to multi-provider clinics, and adapts to the payer mix each practice actually bills.
If TCM windows are being missed, RPM days are falling short, BHI time is not being logged, or split and shared visits are getting misattributed, we can review the panel and show exactly where it is happening.
