What’s the process for calculating average total chiropractic payments?

The Median Payments for Chiropractic Services by County are calculated using MHDO’s APCD commercial claims data from April 1, 2022 – March 31, 2023. These estimates do not include claims for individuals enrolled in Medicaid (MaineCare) or Medicare.

The Steps MHDO Takes to Calculate Chiropractic Procedure Payments on CompareMaine

Step 1: Filter the Data

To create the analytic set, we filter the data by removing claims with missing information, claims from public payors (Medicare and Medicaid), and commercial claims for anyone 65 years old or older, as these claims are often paid for in-part by a public payor like Medicare and including them would distort the average. We do not calculate a payment estimate for a specific procedure if the healthcare setting has fewer than five claims for that procedure in the APCD.

Incomplete Encounters: For procedures that require both professional and facility services, we remove patient encounters that do not include both a professional and facility claim from our estimates.

Encounters Without Payment Data: We remove claims that do not have payment information.

Step 2: Find Claims Linked to a Service or Procedure

We use 13 taxonomy codes from the National Provider Identifier (NPI) Registry to identify chiropractors practicing in Maine and look for the four most common CPT Codes used exclusively by chiropractors:

• Chiropractic treatment, 1+ non-spinal regions (CPT Code 98943)
• Chiropractic treatment, 1-2 spinal regions (CPT Code 98940)
• Chiropractic treatment, 3-4 spinal regions (CPT Code 98941)
• Chiropractic treatment, 5 spinal regions (CPT Code 98942)

Step 3: Calculate the Average Payment

We use the median to calculate the average payment for each of the four chiropractic services listed above by county. We also tally and display the number of providers in each county submitting claims for each service, and the number of times the specific CPT Code appeared in the claims data from April 1, 2022 - March 31, 2023.

The median payments are displayed in graphical and table formats.