Chiropractic

Yes. Claims for diagnostic radiology procedures must be submitted with the name, National Provider Identifier (NPI) and applicable provider qualifier of the provider who ordered the procedure, even though these services are non-covered when ordered or performed by a chiropractor. Radiology procedures submitted without this provider information will be rejected as unprocessable.

Also, non-covered radiology procedures should be billed with a HCPCS modifier GY (statutorily non-covered). Failure to bill the GY HCPCS modifier may result in a "provider not eligible to order/refer" denial, instead of a non-covered service denial.

Instructions for reporting the ordering/referring provider on paper and electronic claims can be found in Items 17 (a-b) of the Interactive CMS-1500 Claim Form Tool.

Last Reviewed: 07/22/2026

Therapy services provided by a chiropractor, although non-covered, must be submitted according to therapy guidelines. Therefore, please be sure to include one of the therapy modifiers defined below. Therapy services submitted without the appropriate therapy modifier, including services submitted with HCPCS modifier GY, will be rejected as unprocessable.

• HCPCS modifier GN — Services delivered under an outpatient speech-language pathology plan of care
• HCPCS modifier GO — Services delivered under an outpatient occupational therapy plan of care
• HCPCS modifier GP — Services delivered under an outpatient physical therapy plan of care

A list of codes that require therapy modifiers is available on the CMS website.

Last Reviewed: 07/22/2026

An Advance Beneficiary Notice (ABN) should only be issued if the provider believes that Medicare may not cover a service because it is not medically reasonable and necessary.

An ABN cannot be issued for services that are being billed with the HCPCS modifier AT. The AT HCPCS modifier serves as an indication that the chiropractor is providing active/corrective treatment to address an acute or chronic subluxation; the modifier may not be submitted when services meet the definition of maintenance therapy.

Additionally, an ABN cannot be issued solely because documentation may not meet Medicare’s guidelines. Without all required documentation, our clinical reviewers cannot establish whether the service rendered was medically necessary. If the service is not documented properly, the claim will deny as contractual obligation, and the beneficiary cannot be billed.

Resources

• Medicare Documentation Checklist & Guidelines for Chiropractic Doctors Educational Tool (PDF) (MLN1232664)
• Medicare Advance Written Notices of Noncoverage (PDF) MLN Booklet
• Chiropractic coverage — Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 240 (PDF)
• Chiropractic services — Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, Section 220 (PDF)
• ABNs and Financial Liability — Pub. 100-04, Medicare Claims Processing Manual, Chapter 30, Section 50 (PDF)

Last Reviewed: 07/22/2026

While not mandated, the Advance Beneficiary Notice (ABN) may be provided to Medicare patients as a courtesy to inform them of their financial responsibility for services that are statutorily excluded from Medicare benefits. Medicare, by law, cannot pay for statutorily excluded services. This includes any service provided by a chiropractor other than manual manipulation (e.g., evaluation and management (E/M) services, physical therapy, nutritional supplements and counseling).

Resources

• Medicare Documentation Checklist & Guidelines for Chiropractic Doctors Educational Tool (PDF) (MLN1232664)
• ABNs and Financial Liability — Pub. 100-04, Medicare Claims Processing Manual, Chapter 30, Section 50.2.1 (PDF)

Last Reviewed: 07/22/2026

To submit a claim for a non-covered service by a chiropractor, use HCPCS modifier GY to indicate that the service is statutorily excluded from coverage. You may submit both covered and non-covered services on the same claim.

Resource: HCPCS Modifier GY.

Last Reviewed: 07/22/2026