Health Costs

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, 2021 – March 31, 2022. These estimates do not include claims for individuals enrolled in Medicaid (MaineCare) or Medicare.

The Steps We Take to Find Procedure Payments

Step 1: Filter the Data

To create the analytic set, we filter the data by removing claims with missing information. We also remove claims from public payers (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 payer like Medicare. Including these claims would distort the average. We do not calculate a payment estimate for a specific procedure if the facility has fewer than 5 claims for that procedure in the APCD.

Incomplete Encounters: Some procedures require professional and facility services. We remove patient encounters that only include either the facility or professional portion.

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

Step 2: Find Claims Linked to a Test or Service

We use 13 different taxonomy codes from the National Provider Identifier (NPI) Registry to identify chiropractors practicing in Maine; and we look for the following 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 Payment

We use the median to calculate the average payment for each of the four chiropractic services listed above by 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, 2021 – March 31, 2022.

The median payments are displayed in graphical and table formats.