Chiropractic care is an essential healthcare service for many New Jersey residents. The problem lies in getting paid for that care, it can be a challenge. Between commercial insurers, Medicare, Medicaid, and the state’s unique no-fault auto insurance system, chiropractors in the Garden State face a minefield of documentation and billing requirements

1. Medical Necessity Must Be Crystal Clear

The #1 red flag? Vague or templated documentation that fails to prove medical necessity

New Jersey insurers expect clear justification for each spinal manipulation. That means connecting the diagnosis to the treatment—no assumptions, no shortcuts. Notes should reflect functional impairments, pain levels, and how treatment is helping the patient improve. Repeating the same note over multiple visits? That’s a fast track to a denial.

Tip: Always document progress. Even a simple line like “Patient reports increased range of motion and decreased frequency of headaches since last visit” strengthens your case.

2. Overuse of 98941 and 98942 Codes

Using higher-level codes (98941 for 3-4 regions, 98942 for 5 regions) too frequently can trigger an audit or automatic denial.

Insurers in NJ often flag chiropractors who bill 98941 as their default. While it may reflect the true treatment, without proper documentation of all adjusted regions and associated diagnoses, payers may label it as “upcoding.”

Tip: Make sure each region treated is both documented and justified by symptoms or findings. If only two regions were clinically necessary, stick with 98940.

3. Mismatch Between Diagnosis and Treatment

Another red flag is a disconnect between the ICD-10 diagnosis codes and the procedure billed. For instance, billing a lumbar adjustment for a cervical-only diagnosis will likely get kicked back..

Tip: Use diagnosis codes that are specific and supported by the clinical findings in your notes. “Back pain” (M54.5) is not enough—go deeper with radiculopathy, segmental dysfunction, or subluxation codes that tie directly to treatment.

4. Missing or Incomplete Initial Exams

Insurers want to see a baseline: a thorough initial evaluation and exam that justifies the treatment plan. If your claim skips this or lacks detail, the rest of the visits become suspect.

Tip: Include detailed initial evaluations with range of motion testing, orthopedic/neurological findings, and a treatment plan with goals and frequency.

5. Excessive or Open-Ended Treatment Planss

Indefinite care—especially without signs of improvement—can lead to denials or requests for records. Insurers look for defined care episodes with measurable outcomes.

Tip: Reassess every 4–6 visits and update the plan. Use outcome measures like pain scales or functional questionnaires to show change.

Instapay’s Takeaway: Be Proactive, Not Reactive

At Instapay Healthcare Services, we help New Jersey chiropractors streamline their billing and avoid insurer red flags before they turn into costly denials. From training your staff on documentation best practices to auditing your claims for compliance, our job is to help you get paid faster—and with fewer headaches.

Need help navigating New Jersey’s chiropractic billing landscape? Let’s talk.