Chiropractic insurance billing in Montana.

Original Medicare Part B covers medically necessary manual spinal manipulation to correct a subluxation (CPT 98940 to 98942). Use the AT modifier for active or corrective treatment; the modifier alone does not establish medical necessity.

For a usually covered service expected to be denied in a particular case, such as spinal manipulation that has become maintenance care, a valid ABN is required before treatment to transfer potential financial liability to the patient. Exams, X-rays and therapies performed by a chiropractor are statutorily excluded from this benefit; an ABN for those services is voluntary. Medicare Advantage uses separate plan coverage and notice procedures, not the Original Medicare ABN. See CMS guidance on advance notices and our chiropractic Medicare billing guide.

Original Medicare Part B claims in Montana are processed by Noridian Healthcare Solutions (JF). Check its applicable Local Coverage Determination and documentation requirements for the date of service.

Carriers listed for Montana include Blue Cross and Blue Shield of Montana; Mountain Health CO-OP; PacificSource Health Plans; UnitedHealthcare; Cigna; Allegiance Benefit Plan Management. Check the member’s product, network, claim destination and applicable chiropractic policy.

Two delegated musculoskeletal/chiropractic network managers operate in Montana.

• American Specialty Health (ASH) administers chiropractic (and often acupuncture/PT/massage) benefits for several national plans active in MT. Cigna delegates chiropractic/PT network management, credentialing, utilization/medical-necessity review, and claims processing to ASH (Cigna’s multi-market expansion of ASH continued through 2023-2024); ASH also historically serves Aetna, Anthem/Elevance, and Health Net lines, For Blue Cross and Blue Shield of Montana (BCBSMT), use Availity Essentials to verify the member’s benefits, claim destination and applicable prior-authorization or recommended-clinical-review process. The published BCBSMT process does not establish a universal ASH chiropractic route.
• Optum / Optum Physical Health (UnitedHealth Group) manages chiropractic and outpatient therapy for UnitedHealthcare: UHC delegates initial authorization and concurrent review for Medicare-covered chiropractic and outpatient therapy to Optum, entered through the UnitedHealthcare Provider Portal and adjudicated in Optum systems. Always verify on the member’s ID card/portal whether chiropractic is carved out to ASH or Optum, because that determines where enrollment, prior auth/treatment-plan submission, and claims are routed. Other significant Montana commercial payers (PacificSource, Mountain Health CO-OP, Allegiance Benefit Plan Management, and BCBSMT’s own products) may administer chiropractic in-house under their own visit caps and prior-auth rules — confirm per plan. Effective October 1, 2026, UnitedHealthcare’s Medicare Advantage reduction list removes prior authorization for spinal CMT 98940-98942. These removals are absent from the separate D-SNP list. Other therapy and commercial requirements remain specific to the member product and code; use the current UHC list and member portal.

What trips up chiropractic billing in Montana:

• Carve-out routing — a leading denial cause. Participating Cigna and other ASH-administered chiropractic products use the ASH Client Summary for the claim destination and review requirements. For BCBSMT, check Availity Essentials and the current prior-authorization or recommended-clinical-review instructions; while UnitedHealthcare routes through Optum via the UHC portal; sending the claim or treatment-plan auth to the health plan instead of the delegated administrator gets it bounced. Confirm the delegated entity on the member’s card before submitting.
• Visit caps and treatment-plan/medical-necessity rules — ASH-administered plans generally impose an annual visit limit and require the chiropractor to submit a treatment plan to ASH for approval, with periodic re-evaluation and a clear shift from active/corrective to ‘maintenance’ care (maintenance is typically non-covered). Among Montana commercial plans, caps vary widely: the cited 2024 PacificSource Montana individual/family example allowed about 10 chiropractic visits per benefit period, with its additional-visit authorization terms, and the 2026 Montana State Employee plan provides a combined chiropractic/acupuncture maximum of 20 days per benefit period — always check the specific Summary of Benefits.
• UHC/Optum MA prior auth — UHC’s MA code list removes prior authorization for spinal CMT 98940-98942 effective October 1, 2026, subject to plan-specific exceptions. The separate D-SNP list does not include these CMT removals. Check the member’s product and CPT; commercial and other therapy authorization rules remain product- and code-specific. ‘Routine’ supplemental chiropractic on some MA plans is a separate, non-Medicare benefit that may not require prior auth.
• Modifiers/coding quirks — Original Medicare spinal CMT 98940-98942 uses AT for active treatment and the applicable GA/GY/GZ rules; exams, X-rays and therapies by a DC are statutorily excluded. MA may add supplemental chiropractic benefits and uses its own coverage and notice terms; distinct-service modifiers must meet the payer’s actual coding criteria.
• Montana chiropractic-specific statutes — Mont. Code Ann. 33-22-111 guarantees insureds ‘freedom of choice’ to select a licensed chiropractor for covered illness/injury within the scope of practice (a self-referral/anti-discrimination protection, not a benefit mandate), and Mont. Code Ann. 33-22-125 requires that any insurer-required independent physical exam of a chiropractic patient be performed by a chiropractor practicing in Montana, and that any records review during an appeal/redetermination of a chiropractic medical-necessity denial be performed by a person trained in chiropractic — useful leverage on utilization-review denials.
• Medicaid scope: Montana’s chiropractic benefit is limited to children age 20 and younger. Routine adult reimbursement is excluded; Medicare cost-sharing is a separate pathway. Verify the covered service and filing requirements; bill within the 12-month window. Not legal advice — verify benefits and current rules per payer.

Commercial initial-filing deadlines follow the provider agreement and member product. MCA 33-18-232 governs the insurer’s proof-of-loss payment clock: generally 30 days, or 60 days after a reasonable information request, with the statute’s notice/fraud conditions for further nonpayment.

When the insurer owes the claim and fails to comply, 10% annual interest is payable if the interest exceeds $5. These are payer obligations, not a uniform provider filing window; track the actual contract deadlines.

Federal limit: generally 12 months (one calendar year) from the date of service to submit an initial Medicare fee-for-service claim. This is set by the Social Security Act (Section 1842(b)(3)(B)) and CMS, not by Montana. Medicare Advantage plans may set their own (often similar, up to ~12-month) deadlines — confirm per plan.

Original Medicare Part B covers medically necessary manual spinal manipulation 98940-98942 to correct subluxation, with AT for active/corrective treatment. Maintenance care is excluded; apply the mandatory ABN and GA/GZ rules when otherwise-covered care is expected to be denied.

DC exams, X-rays, extraspinal CMT and therapies are statutory exclusions; GY and a voluntary notice address those exclusions. Medicare Advantage covers the Part B minimum and may add supplemental chiropractic benefits, using the member plan’s coding and notice procedures.

Effective October 1, 2026, UnitedHealthcare’s Medicare Advantage reduction list removes prior authorization for spinal CMT 98940-98942. These removals are absent from the separate D-SNP list. Other therapy and commercial requirements remain specific to the member product and code; use the current UHC list and member portal.

Montana Healthcare Programs (Montana Medicaid): generally 12 months (365 days) from the LATEST of

• the date of service,
• the date retroactive eligibility is determined, or
• the date disability was determined, to submit a clean claim, per Mont. Admin. R. 37.85.406(1)(a) and the General Information for Providers manual. Exceptions: Medicare crossover claims have 6 months from the date on the Medicare EOB approving the service (if the Medicare claim was timely filed and the member was Medicare-eligible when filed) — Mont. Admin. R. 37.85.406(1)(b); claims following a third-party-liability adjustment have 6 months from the date on the TPL payer’s adjustment notice (when that notice is dated after the periods above) — 37.85.406(1)(c). For a claim adjustment, use the Provider Services Portal’s electronic adjustment process and the instructions in the Department’s applicable rate notice. The submission date is the date the claim is received by the Department or its claims-processing contractor. Confirm current rules in the live provider manual before relying on these.

Montana Workers’ Compensation: providers must submit medical bills within 365 days, absent a showing of good cause. Under Mont. Admin. R. 24.29.1402(1)(c) (effective for dates of service on or after July 1, 2022), a bill is timely received when the employer or appropriate payer actually receives it within 365 days of the LATER of (a) the date of service or (b) the date the provider knew the treatment/services were related to a claim for benefits under the Workers’ Compensation Act.

On the payer side, the insurer must pay medical bills at the fee-schedule rate within 30 days of receipt; if not paid within 30 days, the provider may assess a 1%-per-month interest penalty (Montana unique code MT005), consistent with Mont.

Code Ann. 39-71-704 and the Department of Labor & Industry medical-billing/fee-schedule rules. Bill on a CMS-1500 or UB-04 with supporting documentation. Treatment outside the Department’s adopted utilization & treatment guidelines requires prior authorization from the insurer.

Montana is an at-fault (tort) state with NO no-fault/PIP system and NO fixed statutory deadline for submitting medical bills to an auto carrier. The relevant first-party coverage is optional Medical Payments (Med-Pay), which pays the insured’s medical bills regardless of fault up to the purchased limit; any bill-submission timeframe is set by the individual auto policy , not by statute — submit promptly per policy terms.

Once a clean first-party claim is received, the insurer’s PAYMENT clock is governed by Montana’s prompt-pay law, Mont. Code Ann. 33-18-232 (pay or deny within 30 days of proof of loss, or 60 days if more information is reasonably requested; 10% annual interest for noncompliance when liable); motor-vehicle property-damage claims have an additional prompt-pay statute, 33-18-245.

The underlying third-party liability/personal-injury claim is bound by Montana’s 3-year personal-injury statute of limitations (Mont. Code Ann. 27-2-204), with 2 years for property damage; on a liability/lien basis, bills are typically presented at settlement.

Confirm each Med-Pay policy’s notice/submission terms.