Looking Ahead: 2026 Billing Trends for Chiropractic and PT Practices

As chiropractic and physical therapy practices prepare for 2026, staying ahead of billing trends is critical to ensure compliance, maximize revenue, and adapt to evolving Medicare regulations. Anticipated changes in Medicare policies, advancements in billing technology, and shifts in patient expectations will shape the billing landscape. This comprehensive guide explores key 2026 billing trends, including new CPT codes, stricter compliance requirements, and innovative tools to streamline processes. By understanding these trends and implementing proactive strategies, practices can thrive financially while maintaining patient trust. Practice management tools can enhance efficiency, but the focus is on actionable steps to prepare for the future.

Why 2026 Billing Trends Matter

Billing trends impact revenue, compliance, and patient satisfaction. In 2025, Medicare’s 2.8% payment cut for chiropractic codes (98940–98942) and prior authorization rules for PT services highlighted the need for adaptability. For 2026, practices face potential updates to CPT codes, MIPS thresholds, and technology requirements, which could affect reimbursements by $5,000–$10,000 annually for a practice with 50 claims monthly. Staying informed ensures compliance, reduces denials, and positions your practice for financial success in a competitive healthcare environment.

Key 2026 Billing Trends

Several trends will shape chiropractic and PT billing in 2026, driven by Medicare changes, technology advancements, and patient demands.

1. Evolving Medicare Policies

Medicare is expected to introduce updates that affect billing and compliance.

• CPT Code Updates: New or revised CPT codes for chiropractic (e.g., 98940–98942) and PT services (e.g., 97110, 97140) may be introduced, potentially including codes for telehealth or complex care coordination.
• Prior Authorization Expansion: Medicare may extend prior authorization requirements for additional PT services beyond 97140, especially for high-cost cases exceeding $3,000 annually.
• MIPS Adjustments: Higher thresholds for MIPS eligibility (e.g., $100,000 in Medicare Part B billing) or new quality measures may impact 2028 payments by up to 9%.
• Action: Monitor CMS.gov for the 2026 Physician Fee Schedule, expected in November 2025, to confirm changes.

2. Increased Focus on Value-Based Care

Medicare’s shift to value-based care will emphasize outcomes over volume.

• Chiropractors: Quality measures like “Pain Reduction” or “Patient Satisfaction” will be critical for MIPS reporting, requiring detailed documentation (e.g., P.A.R.T. criteria for 98940).
• Physical Therapists: Measures like “Functional Status Improvement” for 97110 will prioritize patient outcomes, tracked via time logs and goals.
• Action: Update documentation templates to capture outcome-focused data, e.g., “Reduced lumbar pain by 30% after 98940 adjustments.”

3. Advancements in Billing Technology

Emerging technologies will streamline billing and improve efficiency.

• AI-Powered Coding: AI tools may suggest accurate CPT and ICD-10 codes, reducing errors like missing AT modifiers for 98940 or miscounting PT units for 97110.
• Patient Portals: Enhanced portals will offer real-time billing updates and payment options, improving collections.
• Integrated EHRs: 2015 Edition Certified EHRs will support MIPS reporting and interoperability, sharing data with other providers.
• Action: Evaluate tools like Billing Dynamix for AI coding or portal features, but any reliable system works.

4. Rising Patient Expectations

Patients will demand greater transparency and convenience in billing.

• Clear Communication: Patients will expect itemized statements, e.g., “Your 97140 visit cost $60; you owe $20.”
• Digital Payments: Online portals and mobile apps will become standard for paying copays or setting up plans.
• Action: Implement a patient portal and send clear billing FAQs to explain Medicare rules.

5. Stricter Compliance and Audit Scrutiny

Medicare audits will focus on documentation and coding accuracy.

• Chiropractors: Audits may target missing AT modifiers or incomplete P.A.R.T. criteria for 98940–98942.
• Physical Therapists: Time logs for 97110 or 97140 must be precise, e.g., “10:00–10:15 AM,” to justify units.
• Action: Conduct monthly self-audits of 5–10% of claims to catch errors before Medicare reviews.

Strategies to Prepare for 2026 Billing Trends

Proactive preparation will help your practice adapt to 2026 changes and thrive.

1. Stay Informed on Medicare Changes

Monitor updates to ensure compliance and optimize reimbursements.

• Review CMS Updates: Check CMS.gov for the 2026 Physician Fee Schedule and MIPS guidelines by November 2025.
• Subscribe to Industry Resources: Follow ACA and APTA for billing news and webinars.
• Action: Assign a staff member to summarize 2026 changes by December 2025.

2. Update Documentation Processes

Align documentation with value-based care and audit requirements.

• Chiropractors: Revise SOAP notes to include P.A.R.T. criteria, e.g., “Cervical pain, reduced motion, asymmetry noted.”
• Physical Therapists: Standardize time logs and outcome goals, e.g., “97140 from 10:05–10:20 AM to improve shoulder mobility.”
• Action: Update templates by January 2026 to reflect new CPT codes or MIPS measures.

3. Adopt Emerging Technologies

Leverage technology to streamline billing and enhance compliance.

• AI Coding Tools: Use software to flag errors, e.g., missing AT modifiers for 98940.
• Patient Portals: Implement portals for real-time billing and payment access.
• Action: Test tools like Billing Dynamix for AI or portal features in Q1 2026, but any system works.

4. Enhance Patient Communication

Meet patient demands for transparency and convenience.

• Clear Statements: Send itemized bills, e.g., “Your 98940 visit: $50, you owe $15, due 1/31/26.”
• Payment Options: Offer online payments and plans for high balances, e.g., $50/month for a $300 PT balance.
• Action: Launch a patient portal by January 2026 and distribute billing FAQs.

5. Train Staff for 2026 Compliance

Prepare staff to handle new codes, technologies, and patient expectations.

• Train on Updates: Educate staff on 2026 CPT codes, MIPS measures, and prior authorization rules.
• Practice Communication: Role-play explaining bills, e.g., a $50 PT balance due to a denied 97140 claim.
• Action: Schedule a January 2026 training session to cover 2026 changes.

Common Challenges to Anticipate in 2026

These obstacles could impact billing success:

• New CPT Codes: Misusing updated codes for 98940 or 97110 could lead to denials.
• Prior Authorization Delays: Missing approvals for 97140 risks non-payment.
• Incomplete Documentation: Vague notes or missing outcome data fail MIPS or audit requirements.
• Patient Confusion: Unclear bills increase disputes and delay collections.
• Technology Adoption: Slow adoption of AI or portals could reduce efficiency.

Action Plan for 2026 Billing Success

Follow this plan to prepare for 2026 billing trends:

1. Monitor Medicare Updates: Review the 2026 Physician Fee Schedule and MIPS guidelines by December 2025.
2. Update Documentation: Revise templates for P.A.R.T. criteria, time logs, and outcome measures by January 2026.
3. Adopt Technology: Test AI coding tools and patient portals in Q1 2026. Tools like Billing Dynamix can help, but any system works.
4. Enhance Communication: Launch clear statements and a patient portal by January 2026.
5. Train Staff: Conduct a January 2026 training on new codes, MIPS, and patient communication.
6. Conduct Self-Audits: Review 5–10% of claims monthly for coding and documentation errors.
7. Track MIPS Data: Collect quality measure data year-round for 2026 submission.

Benefits of Preparing for 2026 Trends

Proactive preparation offers these advantages:

• Higher Revenue: Adapting to new codes and MIPS could add $5,000–$10,000 annually for a 50-claim practice.
• Lower Denials: Accurate coding and documentation reduce rejections.
• Improved Compliance: Audit-ready records minimize Medicare scrutiny.
• Enhanced Patient Satisfaction: Transparent billing and portals boost trust.
• Operational Efficiency: Technology streamlines processes, saving time.

Tools to Support 2026 Billing

Practice management software can automate coding, patient communication, and MIPS tracking. Systems like Billing Dynamix offer AI coding and portal features, but any reliable tool can help. The key is to adopt technology that enhances compliance and efficiency.

Conclusion

Preparing for 2026 billing trends is essential for chiropractic and physical therapy practices to stay compliant and profitable. By monitoring Medicare changes, updating documentation, adopting technology, and training staff, you can navigate new codes, MIPS, and patient expectations. Use this action plan and reliable tools to position your practice for success in 2026.

Sources

• Centers for Medicare & Medicaid Services (CMS). (2024). 2025 Physician Fee Schedule Final Rule. Retrieved from cms.gov.
• American Chiropractic Association. (2024). Future Trends in Chiropractic Billing. Retrieved from acatoday.org.
• American Physical Therapy Association (APTA). (2024). PT Billing Trends for 2026. Retrieved from apta.org.
• American Medical Association (AMA). (2024). CPT Code Updates for 2026. Retrieved from ama-assn.org.