Chiropractic medical billing: the line between active care and maintenance
Almost every chiropractic denial comes down to one call: was this active treatment, or maintenance? Medicare pays to correct a problem, not to keep a stable patient comfortable. The day a patient stops measurably improving, the care becomes maintenance, and maintenance is never covered. That judgment is a documentation call, not a code, and it is where practices lose the most.
Getting it right means the note has to show the problem, the plan, and real improvement over time, visit after visit. When it just says the patient came in for pain, the payer reads maintenance and denies. This is not a small leak. A 2016 federal review found more than four in five Medicare chiropractic payments did not hold up, almost all of it care that looked like maintenance. The adjustments were fine. The records did not prove they were active.
Commercial plans add their own trap: most cap visits for the year and require reauthorization partway through, so visits keep going out and quietly deny once the cap or the authorization runs out.
Altair is the done-for-you billing service, run by AI, backed by our expert in-house billers. We keep your active care defensible, track the visit caps, and catch the claims that would deny before they go out.
Talk to us, and we will show you where your active care is denying as maintenance.
Common questions
Why does Medicare deny my adjustments as maintenance?
Medicare only covers care that actively corrects a problem. If the note does not show the patient is still measurably improving, continued adjustments read as maintenance, which Medicare never pays. The fix is documentation that proves active care, not a different code.
What happens when a patient plateaus?
Once improvement stops, the care is maintenance. You can keep treating, but you first get a signed waiver from the patient, then submit the visit to Medicare marked as maintenance so it formally denies, and bill the patient from there. Continuing to bill it as active care instead is the top chiropractic audit trigger.
Can Altair handle billing if I have no biller?
Yes. Altair is the done-for-you billing service for solo practices with no billing team, run by AI, backed by our expert in-house billers. We keep active care defensible, track the visit caps, and work the denials.
Sources: HHS Office of Inspector General reviews of Medicare chiropractic payments; CMS chiropractic services coverage and documentation requirements.