Medicare & Chiropractic Billing Simplified

Created by Mark Kennerly, Modified on Thu, 23 Oct at 2:30 PM by Mark Kennerly

A Quick Reference Guide by CARE Medical Billing Inc.

What Medicare Covers

Medicare only covers spinal manipulation to correct a subluxation.

Covered CPT codes:

98940 (1–2 regions)
98941 (3–4 regions)
98942 (5 regions)

These services must be for active treatment (-AT), not maintenance care (-GA).

Exams, therapies, and x-rays are not covered by Medicare.

Pro Tip: Patients with a true secondary payer may have additional coverage — always verify!

What Medicare Does Not Cover

Medicare does not cover the following:

Exams (99201–99215)
Modalities/Therapies (97010–97530)
Maintenance adjustments
Supplements
Orthotics
Nutrition consults

These are patient responsibility unless covered by a true secondary insurance. A Medicare Supplement Plan will not covered non covered services. Collect payment at time of service when applicable.

The ABN (Advance Beneficiary Notice)

Use an ABN when you expect Medicare will not cover a service that is typically covered.

The patient must sign the ABN before the service is rendered.

Keep one copy in the patient’s chart and give one to the patient.

Modifier GA should be used when billing a service with an ABN.

Example: A maintenance visit is not covered → Have patient sign ABN → Collect payment → Submit claim with GA modifier (if submitted at all).

Front Desk Quick Tips

Verify Original Medicare vs. Medicare Advantage.
Confirm if a true secondary plan exists.
Ensure documentation supports “active treatment.”
Use modifier AT for covered spinal manipulation.
Use modifier GA for services with signed ABNs.

Disclaimer: This document provides a simplified overview and should not be considered exhaustive legal or medical billing advice. Always consult official Medicare guidelines and CARE Medical Billing Inc. policies for complete and up-to-date information.