Advancing chiropractic’s voice in healthcare policy

For many providers, coding and documentation may feel like administrative necessities. In reality, they help determine how care is described, reimbursed, analyzed and understood across the healthcare system.

As someone who came to work with the American Chiropractic Association (ACA) after leading a state association, I was very familiar with ACA’s reputation as a respected advocate for chiropractic on Capitol Hill. However, what intrigued me was the expanding influence of its member-led Health Policy and Advocacy Committee (HPAC) in another critical area of policy; one that directly impacts every practicing doctor of chiropractic.

According to the American Medical Association (AMA), Current Procedural Terminology (CPT®) codes describe medical procedures performed by healthcare professionals. They are the common language enabling physicians, payers, regulators, vendors and healthcare technology organizations to document, communicate and understand care provided to patients. They influence not only reimbursement, but also the data, utilization trends, cost patterns and policy decisions shaping healthcare delivery more broadly.

AMA manages the CPT code development and valuation process with the assistance of representatives across the healthcare spectrum. The chiropractic profession is represented by five HPAC members. Leo Bronston, DC, MAppSc, serves on the CPT Editorial Panel, which ensures CPT codes remain current and reflective of patient care. The panel includes representatives from medical specialty societies, private insurers and major healthcare organizations. The Editorial Panel also relies on input and recommendations from groups such as the AMA/Specialty Society Relative Value Scale Update Committee (RUC) and the CPT Health Care Professionals Advisory Committee (CPT HCPAC). Chiropractic is represented on both bodies: current ACA President Kris Anderson, DC, MS, serves on the RUC alongside alternate Cynthia Chapman, DC, PhD, while Della Schmid, DC, represents the profession on the CPT HCPAC with Morgan Price, DC, as her alternate.

Drs. Bronston and Anderson collectively have participated in the CPT process for almost 20 years, learning the ropes along the way and building experience and institutional knowledge. However, the two felt strongly a more intentional pathway was needed to prepare DCs to step into CPT advisory roles. To that end, ACA launched its Health Policy Fellowship in 2024, designed to introduce select members to the coding process over a one-year period, enabling them to gain firsthand experience, while learning the intricacies, nuances and language of healthcare coding policy. In doing so, it helps prepare emerging leaders to engage more effectively in national health policy and advocacy work. Drs. Chapman, Schmid and Price all participated in that first cohort.

“Our overall goal is to develop leaders within the association that express a deeper understanding of these issues and encourage them to advocate on behalf of ACA and the interests of the chiropractic profession in large-scale initiatives,” says Dr. Anderson.

“I wanted to have a deeper understanding of how ACA advocates for us,” shares Dr. Price. “I also wanted to know more about some of these bigger arenas they are involved in that I don’t think are well known. There is a lot of behind-the-scenes work!”

Even for Dr. Schmid, who joined the fellowship as a seasoned chiropractor with the intention of giving back to her profession, the experience proved enlightening. On the HCPAC, she serves alongside more than 50 other types of providers. “One observation I’ve made is that our challenges are very similar,” she says. “I think collaborating with other healthcare providers is extremely important because we learn from them, and they learn from us.”

“Through representation by ACA, AMA CPT and AMA RUC, the chiropractic profession has a voice in the process of creating codes and valuing services provided to patients across the entire healthcare landscape,” notes Dr. Anderson. “We also contribute the expertise and input needed to describe the services provided by chiropractic physicians when those services need reassessment.”

Benefits beyond representation

This engagement produces benefits beyond representation alone. In recent years, ACA has updated many of its coding and documentation guidance resources with AMA review and approval. More than 20 documents are now available to support members with topics ranging from coding for manual therapy, Kinesiology tape and mechanical traction to informational modifiers, dry needling and diagnosis code updates.

These resources do more than support coding accuracy. They also can help strengthen documentation, improve clarity in clinical reporting and provide valuable support when communicating with payers. For practicing DCs, that makes ACA’s work in this space both highly technical and highly practical.

Consider, for example, how the ACA white paper, “Evaluation and Management (E/M) Services on the Same Day as Chiropractic Manipulative Treatment,” can be used by DCs to defend their care to payers. Using AMA resources, the paper clarifies what is expected within clinical documentation to adequately support both CMT and a significant, separately identifiable E/M service. ACA recently obtained expanded copyright from the AMA on the white paper; members now have direct access, while state associations can work with ACA delegates to present it to their members or take it into meetings with payers.

Final thoughts

ACA’s participation in the CPT process is yielding meaningful returns for the profession, strengthening coding and documentation resources and offering new opportunities to advance integration, collaboration and understanding between chiropractors and the wider healthcare community. Just as importantly, it is helping ensure chiropractic has a stronger voice in the systems defining how care is described, valued and advanced.

Brandy Spaulding, DC, is vice president of health policy and education at the American Chiropractic Association. State associations interested in a presentation on the E/M white paper can contact ACA at education@acatoday.org.