Reddenda — Demo Dashboard · Roseville Spine & Sport

Monthly Opportunity

$8,240

Documented this month

Annual Exposure

$98,880

At current run rate

Payers Flagged

4 of 6

Commercial payers

Codes Below Benchmark

5 of 6

CPT codes analyzed

Opportunity Summary

Based on public federal Transparency-in-Coverage filings, CMS Physician Fee Schedule 2026, and peer benchmarks for Chiropractic in Roseville CA, Reddenda identified $8,240/month in documented reimbursement opportunity across 6 CPT codes and 4 payers. Confidence: High. Data basis: Public TiC contracted rates + CMS PFS 2026.

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CPT Code Analysis — Roseville Spine & Sport

6 codes analyzed · Public TiC + CMS PFS 2026 · Chiropractic · Roseville CA · Sample data

CPT

Description

Your Rate

Peer Median

Gap/Visit

Est. Mo. Volume

Mo. Opportunity

Confidence

Data Basis

98941

CMT Spinal 3-4 Regions

$38.50

$52.80

$14.30

180

$2,574

High Confidence

TiC Public Rate

CPT 98941 (CMT Spinal 3-4 Regions) shows a $14.30/visit gap against the CA peer median of $52.80. At 180 estimated monthly visits, this represents $2,574/month in documented opportunity. Anthem Blue Cross and Cigna show the widest gaps relative to public TiC peer data.

Payer Breakdown

Payer	Their Rate	Peer Median	Gap	Status
Anthem Blue Cross	$38.50	$52.80	$14.30	Flagged
Cigna	$36.20	$52.80	$16.60	Flagged
Aetna	$44.10	$52.80	$8.70	Flagged
Blue Shield of CA	$51.40	$52.80	$1.40	Within Range

Evidence

Data basis: TiC Public Rate. Source: Federal Transparency-in-Coverage MRF filings + CMS PFS 2026 Final Rule (CF $32.3471). Peer benchmark: 50th percentile across comparable Chiropractic providers in CA.

Assumptions: Monthly volume estimated from specialty utilization norms for CA. Actual recovery depends on payer response, contract terms, documentation, volume, and negotiation outcome.

Recommended action: Review current contracted rate with Anthem Blue Cross and Cigna. Prepare counteroffer memo citing TiC peer benchmark. Consider requesting rate review at next renewal window.

High Confidence TiC Public Rate

99213

Office Visit Established

$58.40

$78.90

$20.50

120

$2,460

High Confidence

TiC Public Rate

CPT 99213 (Office Visit Established) shows a $20.50/visit gap — the largest per-visit gap in this analysis. UnitedHealthcare and Aetna are the primary contributors. At 120 monthly visits, documented opportunity is $2,460/month.

Payer Breakdown

Payer	Their Rate	Peer Median	Gap	Status
UnitedHealthcare	$58.40	$78.90	$20.50	Flagged
Aetna	$62.10	$78.90	$16.80	Flagged
Anthem Blue Cross	$71.20	$78.90	$7.70	Flagged
Humana	$76.40	$78.90	$2.50	Within Range

Evidence

Assumptions: Monthly volume estimated from specialty utilization norms for CA. Actual recovery depends on payer response, contract terms, documentation, volume, and negotiation outcome.

Recommended action: Review current contracted rate with UnitedHealthcare. Prepare counteroffer memo citing TiC peer benchmark. Consider requesting rate review at next renewal window.

High Confidence TiC Public Rate

98940

CMT Spinal 1-2 Regions

$31.20

$41.60

$10.40

$884

Moderate Confidence

CMS PFS Benchmark

CPT 98940 (CMT Spinal 1-2 Regions) shows a $10.40/visit gap against the CMS PFS 2026 benchmark. Confidence is Moderate as this relies on CMS PFS rather than direct TiC peer data. At 85 monthly visits, opportunity is $884/month.

Payer Breakdown

Payer	Their Rate	Peer Median	Gap	Status
Anthem Blue Cross	$31.20	$41.60	$10.40	Flagged
Aetna	$35.80	$41.60	$5.80	Flagged
UnitedHealthcare	$38.90	$41.60	$2.70	Within Range

Evidence

Data basis: CMS PFS Benchmark. Source: CMS Physician Fee Schedule 2026 Final Rule (CF $32.3471). Peer benchmark: CMS national rates adjusted for CA locality. Direct TiC contracted rate data not available for this code at this practice location.

Assumptions: Monthly volume estimated from specialty utilization norms for CA. Actual recovery depends on payer response, contract terms, documentation, volume, and negotiation outcome.

Recommended action: Review current contracted rate with Anthem Blue Cross. Prepare counteroffer memo citing CMS PFS 2026. Consider requesting rate review at next renewal window.

Moderate Confidence CMS PFS Benchmark

97110

Therapeutic Exercise

$28.60

$36.20

$7.60

$722

Moderate Confidence

CMS PFS Benchmark

CPT 97110 (Therapeutic Exercise) shows a $7.60/visit gap. A recent Aetna TiC MRF filing updated the peer median from $32.10 to $36.20, widening the identified gap. At 95 monthly visits, opportunity is $722/month.

Payer Breakdown

Payer	Their Rate	Peer Median	Gap	Status
Aetna	$28.60	$36.20	$7.60	Flagged
Cigna	$30.10	$36.20	$6.10	Flagged
Humana	$34.80	$36.20	$1.40	Within Range

Evidence

Data basis: CMS PFS Benchmark. Source: CMS Physician Fee Schedule 2026 + updated Aetna TiC MRF filing (May 2026). Peer benchmark: 50th percentile across comparable Chiropractic providers in CA.

Assumptions: Monthly volume estimated from specialty utilization norms for CA. Actual recovery depends on payer response, contract terms, documentation, volume, and negotiation outcome.

Recommended action: Monitor next renewal window with Aetna. Consider bundling with 98941 counteroffer to maximize leverage at renewal.

Moderate Confidence CMS PFS Benchmark

97530

Therapeutic Activities

$31.80

$40.50

$8.70

$652

Low Confidence

Benchmark Estimate

CPT 97530 (Therapeutic Activities) shows an $8.70/visit gap at Low Confidence. This estimate is based on benchmark methodology without direct TiC contracted rate confirmation. At 75 monthly visits, estimated opportunity is $652/month. Verify with actual contracted rate documents before actioning.

Payer Breakdown

Payer	Their Rate	Peer Median	Gap	Status
UnitedHealthcare	$31.80	$40.50	$8.70	Flagged
Anthem Blue Cross	$33.40	$40.50	$7.10	Flagged

Evidence

Data basis: Benchmark Estimate. Source: CMS Physician Fee Schedule 2026 + specialty utilization averages for CA Chiropractic. Direct TiC contracted rate data not confirmed for this code. Confidence is Low — treat as a signal to investigate further, not a confirmed gap.

Assumptions: Monthly volume estimated from specialty utilization norms for CA. Actual recovery depends on payer response, contract terms, documentation, volume, and negotiation outcome.

Recommended action: Confirm current contracted rate from your EOBs or payer portal before pursuing renegotiation. If confirmed below benchmark, include in next renewal discussion.

Low Confidence Benchmark Estimate

98942

CMT Spinal 5 Regions

$52.10

$68.40

$16.30

$948

Moderate Confidence

TiC Public Rate

CPT 98942 (CMT Spinal 5 Regions) shows a $16.30/visit gap — the highest per-visit gap among CMT codes. At 58 monthly visits, documented opportunity is $948/month. Cigna shows the most significant gap relative to TiC peer data.

Payer Breakdown

Payer	Their Rate	Peer Median	Gap	Status
Cigna	$52.10	$68.40	$16.30	Flagged
Aetna	$56.80	$68.40	$11.60	Flagged
UnitedHealthcare	$61.20	$68.40	$7.20	Flagged
Humana	$65.90	$68.40	$2.50	Within Range

Evidence

Assumptions: Monthly volume estimated from specialty utilization norms for CA. Actual recovery depends on payer response, contract terms, documentation, volume, and negotiation outcome.

Recommended action: Review current contracted rate with Cigna. Prepare counteroffer memo citing TiC peer benchmark. Consider requesting rate review at next renewal window.

Moderate Confidence TiC Public Rate

Total

—

613 visits

$8,240/mo

—

Payer Comparison — 6 Payers

Commercial payer rate analysis · Roseville Spine & Sport · CA · Sample data

Anthem Blue Cross

Flagged

CPT codes flagged 4 codes

Avg flagged gap per visit $9.88

Est. monthly exposure $1,824/mo

View in gap matrix ↓

Aetna

Flagged

CPT codes flagged 5 codes

Avg flagged gap per visit $10.10

Est. monthly exposure $1,152/mo

View in gap matrix ↓

UnitedHealthcare

Flagged

CPT codes flagged 3 codes

Avg flagged gap per visit $12.13

Est. monthly exposure $987/mo

View in gap matrix ↓

Cigna

Flagged

CPT codes flagged 3 codes

Avg flagged gap per visit $13.00

Est. monthly exposure $736/mo

View in gap matrix ↓

Blue Shield of CA

Within Range

CPT codes flagged 0 codes

Avg flagged gap per visit —

Est. monthly exposure —

View in gap matrix ↓

Humana

Within Range

CPT codes flagged 0 codes

Avg flagged gap per visit —

Est. monthly exposure —

View in gap matrix ↓

Payer × CPT Gap Matrix

Payer	98941	99213	98940	97110	97530	98942
Anthem Blue Cross	$14.30	$7.70	$10.40	—	$7.10	—
Aetna	$8.70	$16.80	$5.80	$7.60	—	$11.60
UnitedHealthcare	—	$20.50	—	—	$8.70	$7.20
Cigna	$16.60	—	—	$6.10	—	$16.30
Blue Shield of CA	—	—	—	—	—	—
Humana	—	—	—	—	—	—

Gap values shown where the payer is flagged below the peer median. "—" = within range or insufficient data.

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