Billing with the Right Modifiers: Getting Paid Correctly

Using the wrong modifier—or skipping one you needed—remains one of the fastest ways chiropractors lose money, trigger denials, or accidentally raise red flags for payers. In this focused one-hour session, Dr. Evan Gwilliam breaks down the modifiers chiropractors use most often, why they matter, and how to apply them correctly without guessing or overthinking.

We’ll demystify common problem areas such as modifier 25 for same-day exams, modifier 59 (and the X-modifier subset) for distinct procedural services, GP and AT requirements, and payer-specific quirks that create confusion even for experienced providers. Attendees will learn how to ensure their documentation actually supports the modifier they bill, why some combinations trigger audits, and how to prevent denials using simple decision rules that work across most insurance plans.

This session also includes practical examples—what a record must show before modifier 25 is appropriate, when 59 is not your solution, and how to avoid unintentional “unbundling.” All concepts are presented with real-world chiropractic scenarios, so doctors and staff can immediately apply them to daily workflow.

By the end, you’ll know how to match the right modifier to the right service, keep your claims clean, and reduce the risk of post-payment reviews—all while speeding up reimbursement.

After completing this session, participants will be able to:
1. Apply the correct modifiers to chiropractic services such as E/M exams, CMT, and therapeutic procedures.
2. Identify when a modifier is not appropriate, avoiding common errors that lead to denials or payer audits.
3. Ensure documentation supports modifier use, including distinct services, separate exams, and Medicare AT/maintenance distinctions.

Course Breakdown: 

• Why Modifiers Matter
• The Big Four Modifiers for Chiropractors
• Documentation That Supports Modifier Use Real Scenarios, Clean Claims

This course is worth 1 CE credit in ACA-approved and PACE-accepted states. Click here to view a full list of accepted states. 

PACE ID: ON2126

It is the responsibility of each participating doctor to be aware of CE rules and requirements of the state(s) in which he/she is licensed, including acceptable topics for CE and license-renewal credit. Check with your state licensing board for the most current CE information and requirements for your state-related to seminars, webinars or on-demand learning.