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For chiropractic practicesTwo Characters Decide Whether Medicare Pays You At All.
Most specialties argue with payers about how much. Chiropractic argues about whether. Medicare draws a hard line between active treatment and maintenance therapy, and the claim itself has to declare which side of that line the visit sits on. Get the declaration wrong and the payment is not reduced. It is zero.
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Medicare Pays for Active Treatment.
Corrective care for an acute or chronic subluxation. It does not pay for maintenance, however much the patient values it.
The Claim Has to Say Which One It Was.
The AT modifier is the declaration. Without it, the claim is read as maintenance and denied. There is no neutral option.
And the Answer Changes Over Time.
Active treatment ends when maximum therapeutic benefit is reached for that condition. The patient often keeps attending. The payability does not follow them.
AT Is a Claim About the Record.
Its presence does not guarantee payment. A contractor can still review and disagree, and what they review is the documentation behind the assertion.
In a Specialty Built on Small Claims.
High volume, low value each, binary denial rules. Every incentive points toward systematic checking and away from doing it from memory.
An omitted modifier is not a blank. In chiropractic it is a statement that the visit was maintenance.
The detail
Everything below is the evidence for what you just read.
What does the AT modifier actually mean?
When providing active or corrective treatment for acute or chronic subluxation, the AT modifier must be placed on the claim when billing 98940, 98941 or 98942. Claims for medically necessary services must contain the AT modifier or the claim will be denied.[1]
The inverse is the part that costs practices money. When providing maintenance therapy no modifier is required, and claims submitted without the AT modifier are treated as maintenance therapy and denied. There is no neutral state. An omission is an assertion.
The Line Between Active Treatment and Maintenance
Everything below is as Medicare publishes it, cited at the foot of this page.[1][2] These are the published rules, not a CareVixis interpretation, and not a promise about how any particular contractor will review a particular record.
| Where it bites | What the published rule says |
|---|---|
| When AT is required | When providing active or corrective treatment for acute or chronic subluxation, the AT modifier must be placed on the claim when billing 98940, 98941 or 98942. |
| What its absence means | When providing maintenance therapy no modifier is required. Claims without the AT modifier are considered maintenance therapy and are denied. |
| The hard denial rule | MACs deny chiropractic claims for 98940, 98941 or 98942 with a date of service on or after 1 October 2004 that do not have the AT modifier. |
| Where maintenance begins | Once maximum therapeutic benefit has been achieved for a given condition, ongoing maintenance therapy is not considered medically necessary under the Medicare program. |
| What AT does not do | The presence of the AT modifier may not in all instances indicate that the service is reasonable and necessary. Contractors may deny after medical review. |
| What carries the burden | The record, not the modifier. AT is an assertion about the documentation; the documentation is what is examined if the assertion is tested. |
Two rows of that table describe an automatic denial and one describes a discretionary one. That is an unusual risk profile: a chiropractic practice can be denied by a rule with no human involvement, and separately denied by a human who read the note and disagreed.
A Clinical Judgement That Expires
Active treatment is not a permanent status. It is a description of where a patient is in an episode of care, and it ends when maximum therapeutic benefit has been reached for that condition. The patient may well keep coming, and may well benefit from coming, and the visits stop being payable anyway.
So the question a chiropractic practice has to answer, continuously and per patient, is not 'is this treatment helping' but 'is this treatment still improving the condition it was certified for'. Those are different questions with different answers.
Practices rarely lose this money in one event. They lose it by carrying patients past the transition without noticing that the transition happened, and by continuing to submit claims that the record will no longer support if anyone reads it.
What a chiropractic schedule shows
- Visits booked and attended.
- Treatment plan visits remaining.
- Notes signed for the day.
- Charges posted.
What it does not show
- Where each patient sits against maximum therapeutic benefit.
- Which claims went out with AT and whether the record supports it.
- Which denials were the automatic rule and which were medical review.
- How much of today's schedule is likely to be unpayable.
Six Ways a Chiropractic Visit Becomes Unpaid Work
Every one of these describes an adjustment that was delivered and documented. The clinical care is not the problem.
AT omitted on an active treatment claim
The visit was corrective care. The modifier was left off. The claim is read as maintenance and denied automatically, with no human judgement involved.
AT applied after the episode ended
The modifier keeps going out because it always has. Maximum therapeutic benefit was reached weeks ago, and the record will not support the assertion under review.
Documentation that does not track the condition
Notes record what was done rather than what changed. Under medical review, an assertion of active treatment needs evidence of the treatment being active.
The patient who wants to keep coming
Clinically reasonable, commercially unpayable under Medicare. If nobody has that conversation, the practice absorbs the difference silently.
Volume hiding the pattern
A chiropractic practice generates a very large number of very small claims. A recurring denial reason is easy to miss when each instance is worth so little.
Small balances never worked
Individually beneath the cost of staff time to chase. Collectively, the largest recoverable number in the practice.
The practical version of all six: chiropractic is a high-volume, low-value-per-claim specialty where the denial rules are unusually binary. That combination rewards systematic checking and punishes doing it by memory. If you want the revenue cycle around a specific chiropractic system rather than the coding rules themselves, CareVixis publishes that separately: chiropractic billing by EHR.
Where This Fits Around What You Already Run
An illustration of the general flow for a chiropractic practice, not a description of any particular practice or contractor policy.
- Initial examination and treatment planThe episode of active treatment begins and the record starts describing a condition.
- Adjustments delivered98940, 98941 or 98942 depending on regions treated.
- The claim declares its statusWith AT, or without it. There is no third option and no neutral default.
- Maximum therapeutic benefit approachesThe point at which continued care stops being payable, whether or not it stops being useful.
- Remittance comes backPaid, automatically denied for a missing modifier, or denied after review.
- Root cause, not just reworkWhether this is one claim or a pattern across a provider, a payer or an episode length.
- The pattern, and the fixChanging what happens at documentation, not just what happens at appeal.
What Should a Chiropractic Practice Ask a Billing Company?
Nine questions for whoever bills for you now, and for CareVixis. The first three are the ones that reveal whether they have actually billed chiropractic before.
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How do you decide whether AT belongs on a claim?
If the answer is 'we always add it', they are creating audit exposure. If it is 'we add it when the note says so', ask how they read the note.
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How do you track maximum therapeutic benefit per patient?
This is the transition that turns payable care into unpayable care, and most systems do not surface it at all.
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Do you distinguish automatic denials from medical review denials?
They have completely different fixes. A company that reports them together is not telling you anything actionable.
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What is your smallest balance worth working?
In a specialty built on small claims this number determines how much of your revenue is actually pursued.
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How do you report denial reasons back to the clinical side?
The fix for most chiropractic denials lives in documentation, which means it lives with the treating provider.
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Do you perform root cause analysis, as a defined process?
Correcting one modifier gets one small claim paid. Finding the habit is worth multiples of it.
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Can you work with the systems we already run?
A chiropractic practice should not have to replace its software to get its claims looked at properly.
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What visibility do we get, and how often?
Denials by reason and by provider, without asking someone to assemble it by hand.
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Is the work performed in the United States?
CareVixis is 100% US-based with zero outsourcing. Ask anyone else the same question and get the answer in writing.
Using Chiropractic? Keep It.
Your practice software, your scheduling and your notes are yours. Nothing on this page requires changing any of them, and a migration would answer none of the questions above.
Keeping your system is a supported outcome, not a fallback. If you later want to move to the CareVixis platform, that move may be offered at no additional migration charge. Keeping the software you already have carries no monthly software fee from CareVixis.
Keep your software. Change what the claim says, and what happens when it comes back denied.
Questions Chiropractic Practices Ask
When is the AT modifier required?
When providing active or corrective treatment for acute or chronic subluxation, the AT modifier must be placed on the claim when billing 98940, 98941 or 98942. Claims for medically necessary services must contain the AT modifier or the claim will be denied.
What happens to a claim submitted without the AT modifier?
It is treated as maintenance therapy and denied. When providing maintenance therapy no modifier is required, so the absence of AT is not a neutral omission; it is read as a statement about the nature of the care. MACs deny claims for 98940, 98941 and 98942 with a date of service on or after 1 October 2004 that do not carry the modifier.
Does adding AT guarantee payment?
No. The presence of the AT modifier may not in all instances indicate that the service is reasonable and necessary, and contractors may deny after medical review. AT is an assertion about what the documentation shows, which means the documentation is what matters if the assertion is ever tested.
When does treatment stop being payable?
Once maximum therapeutic benefit has been achieved for a given condition, ongoing maintenance therapy is not considered medically necessary under the Medicare program. A patient can continue to attend and continue to value the care; that is a separate question from whether Medicare will pay for it.
Do we have to change our practice software to work with CareVixis?
No. CareVixis can manage the revenue cycle around the systems a practice already uses. If your scheduling and documentation work for your providers, keep them. A practice that later wants to consolidate on the CareVixis platform can do that at its own pace.
Keep Chiropractic. Add Revenue Intelligence.
Keep your practice software. Keep your clearinghouse. Change what the claim declares, and what happens to the small balances nobody has time to chase.
Free. No obligation. No email required.
Sources
- Centers for Medicare & Medicaid Services, Billing and Coding Guidelines for Chiropractic Services (L34585). Source of the requirement to place the AT modifier on claims for 98940, 98941 and 98942 when providing active or corrective treatment, the statement that claims without AT are considered maintenance therapy and denied, and the statement that the presence of AT may not in all instances indicate the service is reasonable and necessary. cms.gov. Accessed 20 September 2026.
- Centers for Medicare & Medicaid Services, MLN Matters SE1602. Source of the statement that MACs deny chiropractic claims for 98940, 98941 or 98942 with a date of service on or after 1 October 2004 that do not have the AT modifier, and of the position that ongoing maintenance therapy is not considered medically necessary once maximum therapeutic benefit has been achieved. cms.gov. Accessed 20 September 2026.
- Centers for Medicare & Medicaid Services, Billing and Coding: Chiropractic Services (A56273), Medicare Coverage Database. Corroborating contractor article restating the AT modifier and maintenance therapy rules above. cms.gov. Accessed 20 September 2026.
CareVixis publishes no denial rate, recovery rate or revenue figure for chiropractic practices. The rules above are what the published sources say. Coverage articles are contractor-specific and are revised; the rules that apply to your practice are those of your own MAC on the date of service, which is one of the things a review should establish rather than assume.
The CareVixis Model, Applied to Medical Billing for Chiropractic Practices
The six CareVixis pillars stay consistent (Revenue Cycle, Credentialing, Technology, Communications, Operations and Growth) while the workflow adapts to this specialty's documentation, coding, payer and operational requirements. Keep the systems that work for you; CareVixis connects responsibility around them.