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$11,840 / month
Based on 6 payers, 9 high-volume CMT and modality codes, and local-market chiropractic benchmark data refreshed Q2 2026 for the Sacramento-Roseville-Folsom CBSA. Annualized recoverable upside: $142,080.
68 / 100
Composite score across CPT-level variance, payer mix balance, and contract-renewal posture. Top-quartile target is 85.
7 of 9
Seven of your nine highest-volume codes are paid below the local-market median on at least one major payer.
4 of 6
Four of the six commercial payers in your network pay below the 25th-percentile rate on your top three codes.
3 ranked
Renegotiate Anthem Blue Cross CA first. Review 98941 down-coding pattern next. Add Aetna escalation flag third.
Top 5 of 9 — gap per claim, monthly impact.
| CPT | Description | Payer | Your avg | Local median | Gap / claim | Recoverable / mo |
|---|---|---|---|---|---|---|
| 98941 | CMT, 3-4 regions | Anthem Blue Cross CA | $42.10 | $54.80 | +$12.70 | $2,540 |
| 98940 | CMT, 1-2 regions (down-coded) | Anthem Blue Cross CA | $32.40 | $41.20 | +$8.80 | $1,936 |
| 97140 | Manual therapy, 15 min | Aetna | $22.90 | $31.60 | +$8.70 | $1,914 |
| 98942 | CMT, 5 regions | UnitedHealthcare | $58.20 | $67.40 | +$9.20 | $1,288 |
| 97014 | Electrical stim, unattended | Cigna | $11.40 | $17.10 | +$5.70 | $912 |
| Sample subtotal · top 5 of 9 | $8,590 / mo | |||||
Three plays. Ranked by dollars recoverable.
Practice Audit clients receive the full negotiation playbook for each of these. Below is the top-line summary.
Renegotiate Anthem Blue Cross CA contract first · +$5,820/mo recoverable
11.4% below local benchmark on 8 of your top 14 codes. Renewal in 162 days. Built leverage packet, formal rate-review request letter, and the negotiator-call script are included with Practice Audit.
Review 98941 → 98940 down-coding pattern · +$3,790/mo recoverable
22% of submitted 98941 claims paid as 98940 across all payers. Suggests systematic down-coding, recoverable via documentation review and payer escalation. The 2026 AAOS documentation standard is in your audit deliverable.
Add Humana escalation flag · +$2,410/mo recoverable
8.8% below benchmark. Renewal in 94 days. File the formal rate-review request within 14 days. Pro tier auto-flags every payer renewal 90 days out, so you never miss another window.
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