Chiropractic insurance billing in Tennessee.

Medicare’s chiropractic rules are federal — the same in every state. Medicare Part B covers ONLY manual manipulation of the spine to correct a subluxation (CPT 98940–98942), and ONLY when the care is active or corrective — which you signal with the AT modifier. Maintenance care, exams, X-rays, and any therapies performed by a chiropractor are not covered, so a properly executed ABN is essential before non-covered services. The full federal rules are in our chiropractic Medicare billing guide.

Part B claims in Tennessee are processed by Palmetto GBA (JJ) — its Local Coverage Determination and documentation expectations (and its audits of the AT modifier and medical necessity) are the ones your Tennessee claims are measured against.

A Tennessee chiropractic or multi-specialty practice spends most of its commercial billing day with: BlueCross BlueShield of Tennessee; Cigna; UnitedHealthcare; Aetna; Ambetter (Celtic/Centene); Humana. Each has its own claim portal, fee schedule, and chiropractic medical-policy quirks.

Tennessee chiropractic claims and prior-authorization do NOT all route to one vendor — delegation varies by payer and line of business, so check the member ID card and the payer portal each time.

• AMERICAN SPECIALTY HEALTH (ASH) — ASH administers chiropractic (and acupuncture, and in many markets physical/occupational therapy) for CIGNA, and Cigna’s ASH arrangement was expanded INTO Tennessee effective September 1, 2021 (per Cigna/APTA announcements). When a Cigna plan delegates to ASH, network contracting, the treatment-plan/medical-necessity review, and CLAIMS route to ASH (ashlink.com), NOT to Cigna directly — so a Cigna chiropractic claim or auth sent to Cigna instead of ASH is a common denial cause; verify on the member card.
• OPTUM / Optum Physical Health (UnitedHealth Group) — manages chiropractic and outpatient therapy for UnitedHealthcare; for UHC Medicare Advantage, prior authorization for chiropractic/PT/OT/ST treatment plans is required (effective 9/1/2024, reviews delegated to Optum via the UHC Provider Portal/Optum systems; the initial evaluation is typically exempt, ongoing care plans need review).
• BLUECROSS BLUESHIELD OF TENNESSEE (BCBST) — the dominant Tennessee carrier — administers chiropractic under its own commercial medical policy (it has not historically carved chiropractic out to ASH statewide); rehab/therapy utilization management may run through its own programs, so confirm whether any musculoskeletal-management vendor applies to a given product.
• TENNCARE MANAGED CARE — chiropractic is handled by each MCO (BlueCare/TennCareSelect via BCBST, Wellpoint/Amerigroup, UnitedHealthcare Community Plan) under TennCare’s adult-chiropractic clinical guideline (prior authorization required) — not a single statewide vendor. Bottom line: route Cigna chiro to ASH (since 9/1/2021), UHC chiro to Optum, BCBST chiro to BCBST’s own policy, and each TennCare plan to its own UM — and confirm everything on the ID card, because delegation changes by plan/product/year.

What trips up chiropractic billing in Tennessee:

• TENNESSEE CHIROPRACTIC EQUAL-REIMBURSEMENT MANDATE — T.C.A. 56-7-2404 requires that when an insurance policy issued in Tennessee covers a service within a licensed chiropractor’s lawful scope of practice, the service must be reimbursed whether performed by an MD or by a licensed chiropractor, and chiropractors may participate in the plan to the same extent (and subject to the same limitations) as physicians. It is a non-discrimination/equalization rule — it does NOT force a stand-alone chiropractic benefit, set rates, or override visit caps, medical-necessity rules, or Medicare/Medicaid program limits.
• TENNCARE COVERS ADULT CHIROPRACTIC BUT WITH PRIOR AUTH — effective January 1, 2022, TennCare requires prior authorization for adult chiropractic services, and the MCOs’ adult-chiropractic clinical guideline mirrors Medicare’s LCD L37254: spinal manipulation (98940-98942) is covered only for an active neuromusculoskeletal condition with a documented subluxation (by x-ray or physical exam) and a reasonable expectation of improvement, in the five spinal regions; maintenance/supportive care and extraspinal (98943) manipulation are not covered. Do not assume a TennCare card means chiropractic is payable without authorization.
• COMMERCIAL VISIT CAPS / MEDICAL NECESSITY — the dominant Tennessee commercial payers (BlueCross BlueShield of Tennessee, UnitedHealthcare, Cigna, Aetna) generally cover spinal manipulation only when medically necessary for an active condition under a documented WRITTEN treatment plan with periodic re-evaluation; ‘maintenance’/supportive care is typically not reimbursable; many plans impose ANNUAL VISIT CAPS (commonly ~20-30 chiropractic/therapy visits per year, plan-dependent — e.g., BCBST plans commonly around 30/year, some Medicare Advantage routine-chiro riders ~20/year) plus unit/code caps per date of service.
• MODIFIER DISCIPLINE — for Medicare and payers mirroring it, the AT modifier must be on spinal CMT 98940-98942 for active/corrective care (no AT = treated as non-covered maintenance and denied); Original Medicare covers ONLY 98940-98942 (never the exam, x-rays, or therapy by a DC), and re-evaluate roughly every 12 visits to support continued necessity. Append modifier 25 to a separately identifiable, separately documented E/M billed the same day as manipulation, or expect a bundling denial; therapy/exercise codes (97xxx) and 98943 often need correct modifiers (e.g., 59/XS, GP) or are denied as not separately payable.
• DELEGATION QUIRKS — send Cigna chiropractic auth/claims to ASH (effective in TN since 9/1/2021), UHC Medicare Advantage chiropractic treatment-plan auth to Optum, and TennCare adult chiropractic through each MCO’s prior-auth process — routing to the wrong entity is a leading denial cause.
• WORKERS’ COMP — treatment must be by an authorized treating physician; chiropractors can treat when authorized, bills go on the CMS-1500 within the 12-month filing window, reimbursement follows the Tennessee WC Medical Fee Schedule, and e-billing rules (0800-02-26) may apply.
• AUTO/MVA — since Tennessee has no PIP, chiropractic MVA care is paid by optional MedPay (to the policy limit), the patient’s health plan, or on a third-party lien/letter-of-protection basis at settlement; Tennessee’s 1-year personal-injury SOL (T.C.A. 28-3-104) makes prompt documentation and lien protection essential. Not legal advice — verify benefits, the managing vendor, visit caps, and auth/treatment-plan requirements per payer before treating.

Largely contract/payer-set, NOT fixed by a Tennessee timely-filing statute. The common initial-claim filing window for commercial/private payers in Tennessee runs roughly 90-180 days from the date of service, though it varies widely by payer, plan, and product (some plans allow up to 12-15 months — e.g., certain BlueCross BlueShield of Tennessee marketplace plans have used a ~15-month window, while many participating-provider agreements use 90, 120, or 180 days).

Always confirm the exact number in your participating-provider agreement or the payer’s provider manual, since it is contractual and can be shorter or longer. Tennessee context: the state’s prompt-pay statute — T.C.A. 56-7-109 — governs how fast the INSURER must adjudicate/pay a CLEAN claim (pay or formally respond within 30 calendar days for paper claims and 21 calendar days for electronic claims, with 1% per month interest on amounts not timely paid); it does NOT set the provider’s SUBMISSION deadline, which remains per the contract.

Note the fully-insured (Tennessee-law) vs. self-funded ERISA distinction — self-funded plans follow the plan document/federal law, so verify which applies.

Federal limit: generally 12 months (one calendar year) from the date of service to submit an initial Medicare fee-for-service (Part B) claim. This is set by Section 1842(b)(3)(B) of the Social Security Act and 42 CFR 424.44 / CMS Medicare Claims Processing Manual (Ch. 1), and applies in Tennessee the same as nationwide.

Tennessee’s A/B Medicare Administrative Contractor (MAC) is Palmetto GBA, Jurisdiction J (Part A and Part B for Alabama, Georgia, and Tennessee). Claims filed after one year are denied as untimely (narrow exceptions apply, e.g., retroactive Medicare entitlement).

Medicare Advantage plans set their own contractual filing deadlines (often up to ~12 months, sometimes shorter) — confirm per plan. For chiropractic, Original Medicare covers ONLY manual spinal manipulation to correct a subluxation (98940-98942) with the AT modifier for active/corrective care — see payerNuance.

TennCare (Tennessee Medicaid) operates almost entirely through managed care (BlueCare/TennCareSelect via BlueCross BlueShield of Tennessee, Wellpoint/Amerigroup, and UnitedHealthcare Community Plan). The TennCare timely-filing standard is 120 DAYS: providers generally must file the claim with the TennCare MCO within 120 days, per TennCare policy PAY 13-001 (Timely Filing) and the TennCare rules at 1200-13-13-.08(12) and 1200-13-14-.08(12).

IMPORTANT START-DATE NUANCE: the 120-day clock does NOT always run from the date of service — where retroactive eligibility or third-party liability (TPL) is involved, the start date is the date TennCare or the MCO/Managed Care Contractor learned of the patient’s enrollment (or the date the other-payer process concluded), not the service date.

(Some general state-comparison charts list Tennessee Medicaid as ’12 months,’ but that conflates other states or FFS edge cases — the operative managed-care standard providers must meet is the 120-day MCO window; confirm the exact deadline and start date with the specific TennCare health plan.) Medicaid is the payer of last resort, so bill other coverage first and watch the TPL/crossover timing.

Tennessee Workers’ Comp: a medical provider must submit its bill within 12 months (one year) of the date of service. This is in the Bureau of Workers’ Compensation Rules for Medical Payments / Medical Cost Containment — Tenn. Comp.

R. & Regs. Chapter 0800-02-17 (the medical-billing rules; the one-year provider filing requirement is reflected at 0800-02-17-.03 and in the Medical Fee Schedule, and a request for Medical Payment Committee review must likewise be made within one year of the date of service).

Separately, on the PAYMENT side, once a properly submitted, complete bill is received the employer/carrier must PAY undisputed amounts within 30 calendar days, and must notify the provider within 15 business days if the bill was not properly submitted (Tenn.

Comp. R. & Regs. 0800-02-17-.10); medical e-billing is required for many payers (Chapter 0800-02-26). Bills must be on the proper form (CMS-1500 for professional/chiropractic services). Submit promptly — the 12-month window is the provider’s filing deadline; confirm each carrier’s specifics and the current Medical Fee Schedule Handbook.

Tennessee is an at-fault (tort) state and does NOT have statutory no-fault Personal Injury Protection (PIP); PIP is not sold here. First-party auto medical coverage is optional Medical Payments (MedPay), which pays accident-related medical bills regardless of fault up to the policy limit (commonly $1,000-$10,000) and cannot be surcharged for use.

There is NO fixed statutory days-from-service deadline to submit a MedPay bill — the deadline is set by the auto POLICY, which typically requires prompt notice of the accident and timely ‘proof of loss’ (itemized bills/records), so submit as soon as possible and follow the policy’s notice/proof-of-loss terms.

Key Tennessee outer limits to protect: the underlying third-party bodily-injury (tort) claim is bound by Tennessee’s UNUSUALLY SHORT 1-year personal-injury statute of limitations (T.C.A. 28-3-104) — among the shortest in the nation — so liens/letters of protection and the patient’s lawsuit must be preserved within one year of the accident; a denied MedPay/insurance benefit is a written-contract claim generally subject to Tennessee’s 6-year limit (T.C.A. 28-3-109).

There is no single ‘bill-submission’ deadline for auto here — it is contractual — so verify each policy and act quickly given the 1-year tort clock.