What’s the process for calculating average total chiropractic costs?
The Median Payments for Chiropractic Services by County are calculated using MHDO’s APCD commercial claims data from April 1, 2019 – March 31, 2020. These estimates do not include claims for individuals enrolled in Medicaid (MaineCare) or Medicare or payments for the uninsured, and do not include what individuals without insurance pay.
The Steps we Take to Find Procedure Costs
Step 1: Filter the Data
To create the analytic set, we filter the data by data by taking out entries with missing or unclear information. At this time, we also remove claims from public payers like Medicare and Medicaid and for those 65 years old or older, as these are often paid for in-part by a public payer like Medicare. Including these claims would distort the average.
Step 2: Find Claims Linked to a Test or Service
Next, we use 13 different taxonomy codes from the National Provider Identifier (NPI) Registry to identify chiropractors practicing in Maine and identify the four most common CPT codes used exclusively by chiropractors:
- Chiropractic treatment, 1+ non-spinal regions (98943)
- Chiropractic treatment, 1-2 spinal regions (98940)
- Chiropractic treatment, 3-4 spinal regions (98941)
- Chiropractic treatment, 5 spinal regions (98942)
Step 3: Calculate the Average Cost
We use the median average each insurer paid for each of the four chiropractic services in each Maine county. We also tallied each county’s number of providers submitting claims for each service, as well as the number of times the corresponding CPT code appeared on claims from April 1, 2019 – March 31, 2020.
The median paid costs are displayed in graphical and table formats and are for reference only. The calculations and results are limited to data from claims meeting the criteria described above. They exclude patients who do not have insurance, services not covered by insurance, or claims where costs were shared by commercial and public payers.