Compare the average cost insurers paid from April 1, 2020 - March 31, 2021 for chiropractic procedures by county.
How to Use This Report
- Select a procedure and payer to view the estimated costs by county (available in map and table formats).
- Hover over the map for detailed information, including the county, the number of times commercial insurer(s) paid for the procedure during the reporting period, and the number of chiropractors in each county who billed insurer(s) for the procedure.
Patients may receive multiple types of treatment in a chiropractic appointment. If more than one service is received during the same visit, look up the cost of each service and add them together to get the estimated total cost.
The cost estimates are calculated using commercial claims from April 1, 2020 – March 31, 2021 from MHDO’s All-Payers Claims Database (APCD). The estimates do not include claims for individuals enrolled in Medicaid (MaineCare), Medicare, payments for the uninsured, or what individuals without insurance pay.
The Steps to Calculate Procedure Costs
Step 1: Filter the Data
To create the analytic set, we filter the data by data by taking out entries with missing or unclear information. At this time, we also remove claims from public payers, Medicare and Medicaid and for those 65 years old or older, as these claims are often paid for in-part by a public payer like Medicare.
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. We also have identified the 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 Cost
We use the median value rather than the mean to come up with the average cost each insurer paid for each of the four most common CPT codes billed by chiropractors. We believe the median is better than the mean for summarizing averages in healthcare because it represents the amount that a procedure is most likely to cost and is less likely to be influenced by extreme values. Counts are tallied and displayed for the number of times the procedure appeared in the data during the reporting period (this number includes the data from the public payers), and the number of providers in each county who submitted claims for the procedure.
The calculations and results are limited to data from claims meeting the criteria described above.