What’s the exact process for calculating cost?
The chiropractic cost data are calculated using MHDO’s APCD commercial claims data from January 1, 2017 through December 31, 2017. 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 first filtered the data by removing claims submitted by public payers, claims for individuals age 65 or older, incomplete claims, or claims with no cost data.
Step 2: Find Claims Linked to a Test or Service
Next, we used 13 different taxonomy codes from the NPI Registry to identify chiropractors practicing in Maine, and then identified 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 then went on to find the median average amount each insurer paid for each of the four chiropractic services in each Maine county. The median paid costs are displayed in graphical and table format. 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 January 1, 2017 through December 31, 2017.
These numbers 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.