You might have asked yourself why the price of Chiropractic Care varies from office to office? You could take
that question further by asking why the amount of care for the price changes from office to office? These
questions have been presented several times by myself and patients alike for decades.
There are two main contributing factors to setting fees for Chiropractic Care: Medicare and Workers’
Compensation fee schedules. The former is in place if the Chiropractor has contracted to be a Medicare
provider. The later is in place by the state the Chiropractor is in at an established practice. Medicare has an
established fee schedule that a Chiropractor must adhere to or face penalties for over charging patients. That
being said, Medicare has determined what is the limiting charge a Chiropractor can assess for a service
performed. The limiting charge is 80% of the fee for a service and the other 15% is what the patient would be
responsible for. Medicare only has control over the price of the spinal manipulation/adjustment because this is
the only area that the contract between Medicare and a Chiropractor is in control of. These procedures of
manipulation have codes that are used to bill for these services.
They are 98940, 98941, & 98942.
98940 represents the procedure of adjusting 1 – 2 areas of your spine.
98941 represents the procedure of adjusting 3 – 4 areas of your spine.
98942 represents the procedure of adjusting all 5 areas of your spine.
Any other service that is rendered in a Chiropractic office is usually established under the fee schedule set forth
by the states’ Workers’ Compensation Board.
While there are many styles of fees for service among Chiropractic offices, some are legal in their fee schedules
while others may come under the scrutiny of the Office of Inspector General (OIG). Chiropractic offices that
offer membership for services can set their own prices without being under this scrutiny because you have
established a contract with them. They cannot bill Medicare for these services because it is against the rules of
providing care for a Medicare recipient. There are those offices that charge a one price gets all you need for the
visit (spinal adjustment, extremity adjustment, massage, hot packs, muscle stimulation, etc.). Truly, these are
those offices that can be involved in an investigation by the OIG, due to the fallacy of one price gets all. The
current correct system for charges of services rendered is by following the Medicare limiting charge for the
region the Chiropractor is adjusting and then adding 15%. This fee schedule changes yearly, and it is up to each
office to stay abreast of the current fee schedule.
Thus, because I am a contracted non-participating Medicare provider my current fees for 2022 are as follows;
98940 is the code for adjusting 1 – 2 spinal regions $33.00
98941 is the code for adjusting 3 – 4 spinal regions $48.00
98942 is the code for adjusting all 5 spinal regions $62.00
98943 is the code for adjusting ribs, upper or lower extremity $30.00
98944 is the code for adjusting ribs, upper and lower extremity $41.00
First Chiropractic Visit Examination Fee $25.00
Chiropractic Manual Therapy to muscles and tendons $6.00 per 5-minute intervals
I hope this gives a little more light into the world of Chiropractic Care for you in the future, Dr Doug!
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