Chiropractic Practices Industry Terminology

ABN (Advance Beneficiary Notice)

A CMS-required notice informing Medicare beneficiaries that a service may not be covered and that the patient may be financially responsible.

ABN signed before non-covered maintenance care; Append GA modifier to indicate ABN on file; Issue ABN when traction is requested by a Medicare patient.

Activator Method

An instrument-assisted, low-force chiropractic technique using a spring-loaded device to deliver precise thrusts.

Use the Activator on C1 for a low-force cervical adjustment; Good option for osteoporotic or pediatric patients; Market certification as Advanced Proficiency Rated in Activator.

Acute Care

Short-term, symptom-focused treatment phase addressing recent-onset conditions with the goal of rapid relief and stabilization.

Plan 3 visits per week for 2 weeks for acute low back pain; Transition from acute to corrective care after symptom stabilization; Medicare covers active (acute/subacute) treatment but not maintenance.

Adjustment

A manual or instrument-applied thrust to restore joint motion and function, often delivered as high-velocity, low-amplitude (HVLA) manipulation.

Diversified lumbar adjustment in side posture; Thoracic adjustment prone at T4–T6; Document segments adjusted and patient tolerance.

AT Modifier (Active Treatment)

A Medicare modifier appended to chiropractic manipulative treatment (CMT) codes to indicate that care is active/medically necessary, not maintenance.

Append AT to 98941 on Medicare claims to indicate active care; Omit AT on maintenance visits; Claim denial occurred when AT modifier was missing.

Board of Chiropractic Examiners

The state regulatory authority that licenses chiropractors, enforces scope and standards, and oversees disciplinary actions.

Submit CE credits to the Board annually; Verify scope questions with the Board; Report any disciplinary actions to the Board promptly.

Cash Practice

A practice model in which patients pay directly for services, with little or no third-party billing.

Offer a time-of-service discount in a cash model; Provide a superbill so patients can self-submit; No payer contracts—100% direct-pay practice.

Care Plan

A structured, patient-specific plan specifying frequency, duration, interventions, goals, and reassessment schedule.

2x/week for 4 weeks, then re-exam; Goals: reduce ODI by 10 points and restore full lumbar ROM; Include home exercises and ergonomic advice.

Cavitation

The audible pop sometimes heard during manipulation, caused by gas bubble formation and collapse within the joint.

Cavitation heard at C5 during rotation adjustment; Reassure patients that no pop doesn’t mean no correction; Avoid chasing cavitation as the outcome measure.

CMS (Centers for Medicare & Medicaid Services)

The federal agency administering Medicare/Medicaid and issuing coverage, billing, and documentation policies.

CMS covers spinal manipulation to correct subluxation; Follow CMS documentation requirements; Review local coverage determinations (LCDs) for your MAC.

CPT CMT Codes 98940–98942

CPT codes for chiropractic manipulative treatment, billed by number of spinal regions treated.

98940 for 1–2 spinal regions, 98941 for 3–4, 98942 for 5; Add AT for Medicare active care; Documentation must list regions and subluxation diagnosis.

Decompression Therapy

Mechanical traction aimed at reducing disc pressure and relieving nerve compression, often delivered via specialized tables.

Bill mechanical traction as 97012 when appropriate; Offer decompression package for disc herniation cases; Screen out contraindications like spinal instability.

Diversified Technique

A widely taught manual adjusting approach emphasizing high-velocity, low-amplitude thrusts with specific segmental contacts and set-ups.

Side-posture lumbar HVLA; Prone thoracic set-up at T6; Use Diversified as primary technique with modifications for patient comfort.

Documentation

Complete, legible clinical records that support medical necessity, coding, and continuity of care.

Use SOAP format and link diagnoses to procedures; Record objective measures like ROM and VAS; Ensure notes justify medical necessity and time for timed codes.

E/M Coding

Evaluation and Management coding for history, exam, and medical decision making (or time) in new and established patient visits.

99203 for a low-level new patient visit; Append 25 modifier when a significant, separate E/M occurs with CMT; Determine level by MDM or time per 2021 guidelines.

EHR (Electronic Health Record)

Digital platform for creating, storing, and exchanging patient health information, often integrated with scheduling, billing, and outcomes.

Customize macros for chiropractic SOAP notes; Integrate e-prescribe of DME like orthotics; Ensure encryption and access controls for HIPAA compliance.

Evidence-Based Practice (EBP)

Clinical decision-making that integrates best research evidence, clinician expertise, and patient values.

Combine clinical experience with RCTs showing benefit of SMT plus exercise; Use guidelines for acute low back pain triage; Include patient preferences in plan selection.

Fee Schedule

A list of charges for each service and product provided by the clinic or allowed by a payer.

Post a transparent fee schedule; Align fees with local UCR; Review payer fee schedules to identify underpayments.

Gonstead Technique

A system of analysis and adjusting emphasizing specific listings, instrumentation, palpation, and X-ray analysis.

PRS listing at L5 corrected on pelvic bench; Knee-chest cervical adjustment; Full-spine X-rays used to determine listings.

Google Business Profile (GBP)

Google’s local business listing that influences maps placement, reviews, and local SEO.

Update GBP hours, services, and photos; Ask for reviews to improve local search; Track calls and visits from GBP insights.

High-Velocity Low-Amplitude (HVLA)

A rapid, small-amplitude thrust characteristic of many manual adjustments that aims to restore joint motion.

HVLA thrust to T6 with cavitation; Avoid HVLA with acute fracture or severe osteoporosis; Practice precise line-of-drive to reduce force.

HIPAA

US law establishing standards for privacy, security, and electronic exchange of protected health information (PHI).

Provide Notice of Privacy Practices; Encrypt PHI and use role-based access; Report breaches per HIPAA timelines.

ICD-10-CM

The diagnostic coding system used to classify diseases and conditions for claims and documentation.

M54.50 for low back pain; M99.03 for segmental dysfunction of lumbar region; Link each diagnosis to the services performed.

Informed Consent

A process by which the clinician explains risks, benefits, and alternatives, and the patient voluntarily agrees to care.

Discuss risks and alternatives of cervical manipulation; Obtain written consent on Day 1 and update as needed; Document consent for telehealth services.

Laser Therapy (LLLT)

Low-level laser used to modulate inflammation, reduce pain, and promote tissue healing.

Apply 3–6 J/cm² to lateral epicondyle; Use laser for tendinopathy as an adjunct to exercise; Avoid over malignant lesions.

Maintenance Care

Elective, periodic care to maintain function and prevent symptom recurrence after goals of active treatment are met.

Monthly visits to prevent relapse after acute recovery; Not covered by Medicare; Reassess periodically to confirm ongoing benefit.

Malpractice Insurance

Professional liability insurance covering claims arising from alleged negligence or errors in practice.

Choose between claims-made or occurrence policies; Obtain tail coverage when changing carriers; Report potential incidents promptly.

Medical Necessity

The standard that services are reasonable and necessary for diagnosis or treatment, supported by objective findings and functional goals.

Tie goals to functional deficits (e.g., ODI, ROM); Use objective improvement to justify continued care; Insurer denied when documentation lacked functional goals.

Modifier 25

CPT modifier indicating that a significant, separately identifiable E/M service occurred on the same day as another procedure.

99213-25 billed with 98941 when separate and significant E/M is performed; Ensure distinct documentation for the E/M; Avoid blanket use—apply only when criteria are met.

Motion Palpation

Manual assessment of joint motion and end-feel to identify restrictions or dysfunction.

Fixation at T4 on extension; Compare end-feel right vs left at C3; Use findings to guide adjustment selection.

NDI (Neck Disability Index)

A validated, patient-reported outcome measure quantifying neck-specific disability.

Baseline NDI 34% indicating moderate disability; Improvement of 16 points after 4 weeks; Use NDI to assess neck-related function at re-exam.

ODI (Oswestry Disability Index)

A widely used questionnaire measuring low back pain-related disability.

ODI 48% indicates severe disability; Target a 10-point improvement over 4 weeks; Reassess ODI to document medical necessity.

Orthotics

Custom or prefabricated foot devices to support alignment and biomechanics, sometimes dispensed by DCs within scope.

Scan feet for custom orthotics; Bill L3020 when appropriate; Use orthotics to address overpronation in plantar fasciitis.

Patient Visit Average (PVA)

A business metric showing the average number of visits per new patient episode of care.

PVA of 12 suggests strong retention; Track PVA monthly as a KPI; Improve PVA via clear ROF and follow-up systems.

Range of Motion (ROM)

The measurable movement of a joint in degrees or qualitative end-feel, used for assessment and outcomes.

Lumbar flexion limited to 40 degrees; Use inclinometer to document ROM changes; ROM improved after four visits of SMT plus exercise.

Red Flags

Clinical signs or symptoms indicating possible serious pathology requiring urgent workup or referral.

Screen for cauda equina, cancer history, and infection; Immediate referral for progressive neurological deficit; Document negative red-flag screen in initial exam.

Report of Findings (ROF)

A structured visit where the clinician explains the diagnosis, treatment plan, expected outcomes, risks, and financials.

Present diagnosis, plan, schedule, and fees on Day 2; Use models to explain disc pathology; Confirm informed consent during ROF.

Revenue Cycle Management (RCM)

The end-to-end process of capturing charges, coding, billing, posting, and collecting revenue for services rendered.

Improve clean claim rate and reduce denials; Monitor days in AR and collection percentage; Consider outsourcing RCM to a specialized vendor.

Scope of Practice

The legal parameters defining what services a chiropractor can provide in a given jurisdiction.

Verify whether dry needling is within state scope; Check rules for ordering MRI or X-ray; Telehealth allowances vary by scope and jurisdiction.

SOAP Notes

A standardized format for daily progress notes: Subjective, Objective, Assessment, Plan.

Subjective: VAS 7/10; Objective: reduced lumbar ROM; Assessment: acute lumbar strain; Plan: SMT and 97110; Complete daily SOAP within 24 hours.

Spinal Manipulative Therapy (SMT)

A manual therapy intervention that includes spinal adjustments/manipulations to improve joint function and reduce pain.

SMT plus therapeutic exercise for chronic LBP; Document region, technique, and patient response; Avoid SMT with acute fracture.

Telehealth

The delivery of health-related services and information via telecommunications, including video visits and remote monitoring.

Virtual rehab check-ins for home exercise progressions; Use 95 modifier for synchronous telehealth where applicable; Confirm licensure and payer policies before virtual visits.

Therapeutic Exercise (97110)

A timed CPT code for one-on-one exercise aimed at improving strength, endurance, range of motion, and flexibility.

Bill 97110 for 15 minutes of one-on-one exercise; Document measurable goals and patient response; Pair with SMT when medically necessary.

Thompson Drop-Table Technique

An adjusting method using table sections that drop to assist the thrust and reduce required force.

Pelvic drop for PI ilium correction; Leg-check protocol guides set-up; Use drop pieces to deliver low-force adjustments.

Trigger Point

A hyperirritable spot in skeletal muscle associated with a taut band, tender on compression, and capable of referring pain.

Palpable trigger point in upper trapezius with referred pain to the head; Apply ischemic compression 60–90 seconds; Teach self-release with a lacrosse ball.

UCR (Usual, Customary, and Reasonable)

A benchmark of typical charges in a geographic area used by some payers to determine allowable amounts.

Set fees near UCR for the area; Payer reimburses at 80% of UCR; Review UCR benchmarks annually.

Verification of Benefits (VOB)

The process of confirming a patient’s insurance eligibility, coverage details, and limitations before providing services.

Call payer to verify copay, deductible, and visit limits before Day 1; VOB revealed a 12-visit annual limit; Record the reference number and rep name in the chart.

Visual Analog Scale (VAS)

A 0–10 subjective scale used to quantify pain intensity, often tracked over time.

Initial VAS 7/10, reduced to 2/10 after 4 visits; Track VAS at each appointment; Use VAS changes to support medical necessity.

Wellness Care

Elective, preventive care aimed at maintaining optimal function and lifestyle, beyond resolution of the presenting complaint.

Quarterly check-ins for spinal hygiene; Emphasize lifestyle factors like sleep and activity; Not covered by Medicare—offer membership plans.

X-ray (Radiography)

Imaging modality used for structural assessment, ruling out pathology, and some technique-specific analyses.

Order lumbar films when red flags or trauma are present; Use full-spine films in some technique systems; Apply ALARA principles to minimize exposure.