Rejected claims are the single biggest drain on a chiropractic practice’s revenue cycle. Most of them come down to modifiers — the two-character codes that tell payers how a service fits into the clinical picture. A wrong modifier turns a clean claim into an appeal. A missing modifier turns a paid claim into a denial. And in 2026, every payer has a slightly different idea of which modifier belongs where.

The five modifier errors that cost practices the most

  1. AT on maintenance care. The Active Treatment modifier is only valid for services that meet Medicare’s definition of active care. Maintenance visits are non-covered and need the GA or GY modifier instead.
  2. GA without a signed ABN on file. The GA modifier signals that an Advance Beneficiary Notice was issued and signed. If the ABN is not in the chart, the modifier is a lie to the payer and an audit risk to the practice.
  3. 25 missing on separately identifiable E/M visits. If a provider does a separately identifiable E/M on the same day as an adjustment, modifier 25 is required — and most payers will deny the E/M without it.
  4. 59 when 25 is correct. The two modifiers are frequently confused. 59 is for distinct procedural services. 25 is for significant, separately identifiable E/M. They are not interchangeable.
  5. KX for carriers that do not accept it. Not every payer honors the KX modifier for threshold exceptions. Using it on the wrong payer is a free denial.

How the Platinum scrubber handles these

The IBS team has cataloged the top ten recurring modifier errors we see across thousands of claims a month. We publish corrections in the Platinum rules engine so every clinic on the platform benefits the moment we find a new pattern. If you are on Platinum, the scrubber already knows. The rule is updated centrally, rolled out immediately, and the next claim that would have triggered the error is corrected at the point of entry.

If you are not on Platinum yet

If you are not — and you are reading this during a month when your AR aging is creeping — this is the guide to start with. Six quick fixes, two prevention rules, and one phone call you should probably make before the next payer cycle closes. And if you want the full catalog, the IBS team is one request form away.