How to Avoid Claim Denials in Chiropractic Billing

Denied claims are more than just an administrative headache; they’re a direct hit to your chiropractic practice’s cash flow. Whether you’re running a solo clinic or managing a multi-provider office, dealing with rejected claims from insurance companies can stall revenue, increase workload, and impact patient satisfaction.

In 2025, the billing environment for chiropractic services will become even more stringent. Payers are doubling down on documentation requirements, enforcing strict medical necessity rules, and rejecting claims for even the smallest coding or modifier errors. Many chiropractic practices are seeing an increase in claim denials, even for routine procedures.

Denials are preventable when the right practices are implemented. With the right strategies, systems, and awareness of payer expectations, your practice can significantly reduce its rejection rate and improve reimbursement outcomes. This guide walks you through the most common causes of chiropractic claim denials and how to avoid them.

Claim Denials in Chiropractic Billing

In chiropractic billing, denials are routine. Unfortunately, too many providers accept them as part of doing business, and we believe it should not be the case. In reality, most denials stem from a small set of recurring errors that can be addressed with better workflows, smarter technology, and attention to compliance. The most common reasons for chiropractic billing claim denials include:

Incomplete or inaccurate documentation
Lack of medical necessity
Missing or incorrect modifiers
Use of outdated CPT codes
Inconsistent treatment plans
Errors in patient information or eligibility
Failure to meet pre-authorization requirements

For example, spinal manipulation services (coded under 98940–98942) are frequently denied when documentation doesn’t support the diagnosis or treatment rationale. Even if the service was medically appropriate, if the note lacks clarity or justification, the claim may be rejected. The key to reducing denials lies in understanding what insurers expect and meeting those expectations every time.

Documentation Is the Foundation of Clean Chiropractic Claims

Clean claims start with clear, consistent, and compliant documentation. For chiropractic services, this means more than just stating a diagnosis and procedure. Payers expect to see a documented clinical rationale for treatment, including the patient’s symptoms, functional limitations, objective findings, and response to care.

The documentation standards continue to rise with the changing healthcare landscape. Payers want proof that each spinal adjustment is medically necessary, not just routine maintenance. This is particularly important for services billed repeatedly over time. Using vague terms like “subluxation” or “routine care” without clinical backup can trigger an audit or denial. To support medical necessity, ensure your notes include:

Subjective complaints (what the patient reports)
Objective findings (what the provider observes)
Assessment (clinical interpretation of the findings)
Plan (treatment goals and next steps)

This SOAP note format is still the industry standard, and when used correctly, it provides the payer with a clear picture of why care is needed. With MaxRemind, our AI-driven billing platform can even scan documentation in real-time and alert you if a claim lacks necessary details so that you can fix it before submission.

Modifiers Make or Break Your Chiropractic Claim

Using modifiers correctly requires staying up to date with payer-specific rules. Some insurers want the AT modifier only for initial visits; others expect it on every visit. That’s why MaxRemind’s platform has built-in payer logic. It automatically applies the right modifiers based on the insurer’s latest requirements, helping to reduce human errors.

GA : Waiver of liability statement issued
GZ : Service expected to be denied as not reasonable and necessary
25 : Significant, separately identifiable E/M service on the same day

Other important modifiers include:

Modifiers tell the insurer exactly how a service was delivered. They may seem like small code add-ons, but misusing them, or forgetting to use them at all can lead to instant denials. In chiropractic billing, the most common modifier-related denials occur around modifier AT (Active Treatment). This modifier must be attached to spinal manipulation codes (98940–98942) when the service is medically necessary. If you omit it, the insurer may assume the treatment was maintenance care, which is not typically covered.

Coding Errors Are a Top Reason for Denials

Chiropractic CPT codes may seem straightforward, but even small missteps in code selection can trigger denials. For example, many providers mistakenly use 98942 (manipulation of five spinal regions) when documentation supports only three regions, which should be billed as 98941. Overcoding (billing for more complex services than were performed) and undercoding (billing for less) both raise red flags. In 2025, payers are using automated systems to cross-reference CPT codes against diagnosis codes and documentation. If anything appears inconsistent, the claim is flagged or rejected outright.

To avoid coding-related denials:

Use the correct CPT code based on documentation
Match diagnosis codes (ICD-10) to the area treated
Avoid “upcoding” spinal regions for higher reimbursement
Review codes quarterly to ensure compliance with updates

MaxRemind’s AI-driven coding assistant reviews each claim before submission, matching diagnosis codes to procedures and flagging potential mismatches or outdated codes. That way, your claims go out clean the first time.

READ HERE: A Beginner’s Guide to Medical Coding Accuracy

Pre-Authorization and Eligibility Verification Are Non-Negotiable

Another major source of denials in chiropractic billing is failure to verify insurance coverage or obtain necessary authorizations. Some plans require prior approval before covering certain chiropractic services, especially those beyond an initial visit or outside a treatment window. Verifying eligibility and benefit coverage before every visit. Patients may change plans mid-treatment, or coverage may reset at the start of the year.

Best practices include:

Verifying patient eligibility before every session
Documenting any policy limitations (e.g., visit caps, exclusions)
Tracking pre-authorizations and expiration dates
Communicating clearly with patients about their responsibilities

With MaxRemind, eligibility checks can be automated through our platform. Our system pulls real-time data from insurers and alerts your staff if coverage has lapsed, an authorization is missing, or if a visit limit is approaching, preventing denials before they happen.

When Claims Are Denied, Have a Plan to Appeal

Even the most compliant practices will occasionally face a denial. The important thing is what happens next. Too many practices leave money on the table by not appealing, or by appealing without understanding the reason for rejection.

Appeals should be fast, targeted, and backed by documentation. When a chiropractic claim is denied for lack of medical necessity, your appeal should include a detailed treatment rationale and evidence of patient progress. If the denial is coding-related, clarify the intent and include corrected codes.

READ HERE: How Denial Management Helps You To Lower Your Claim Rejections

At MaxRemind, our denial management tools automatically flag rejected claims, assign follow-ups to your billing team, and even generate pre-filled appeal templates. This shortens the turnaround time and increases your chances of recovering revenue.

Leveraging Technology and Process to Reduce Denials

Preventing chiropractic claim denials requires more than just attention to detail; it requires a system. Successful practices combine staff training, smart documentation, proper coding, and reliable billing technology to eliminate common mistakes.

If your current billing setup involves manual data entry, limited reporting, or constant guesswork about payer rules, it’s time to upgrade. MaxRemind’s chiropractic billing platform is designed specifically to address the challenges unique to this field. From claim scrubbing and modifier logic to documentation alerts and denial analytics, we help practices stay compliant and get paid faster.

Take Control of Your Chiropractic Billing Process

Claim denials don’t have to be a routine part of running a chiropractic practice. With the right workflows, smarter software, and attention to payer rules, you can reduce denials, boost revenue, and spend less time chasing payments.

MaxRemind partners with chiropractic clinics to make billing simpler, smarter, and more efficient. Whether you’re handling billing in-house or ready to outsource, our AI-powered solutions are built to prevent the very issues that cause denials in the first place.

Get in touch today to schedule a free practice audit and see how we can help you avoid denials and recover the revenue you’ve already earned.

Ready to upgrade your Chiropractic billing workflow?

Request a free audit or demo from MaxRemind today, and see what modern RCM support looks like for alternative care.

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FAQs

What are the most common reasons for chiropractic billing claim denials?: The most frequent causes include missing or incomplete documentation, use of incorrect CPT codes, lack of medical necessity, failure to use required modifiers like AT, and not obtaining prior authorization. Eligibility issues and errors in patient information can also trigger denials.
How can I reduce claim denials in my chiropractic practice?: Start by improving documentation accuracy, using correct CPT codes, verifying insurance coverage before each visit, and understanding payer-specific modifier rules. Implementing a billing platform like MaxRemind can automate many of these checks and reduce human error.
Do I need to use the AT modifier for every chiropractic claim?: If the service is medically necessary and not maintenance care, the AT modifier is generally required for spinal manipulation codes. However, requirements can vary by payer, so always check insurer-specific guidelines.
What role does documentation play in avoiding denied chiropractic claims?: Proper documentation is the foundation of claim approval. SOAP notes should justify treatment with clinical findings, diagnosis, and patient progress. Insufficient or vague notes can lead to denials, even when treatment was appropriate.
How does MaxRemind help prevent chiropractic claim denials?: MaxRemind uses AI-powered tools to scrub claims, apply correct modifiers, flag documentation issues, and automate eligibility checks. The platform also alerts billing teams to payer-specific rules and supports efficient denial management and appeals.
Is there a way to appeal a denied chiropractic claim?: Yes. You can appeal most denied claims by submitting a detailed explanation, corrected documentation, and supporting clinical evidence. MaxRemind’s platform simplifies this with ready-to-use appeal templates and automatic tracking of rejected claims.