CPT Codes 98940, 98941, 98942 Explained for Accurate Chiropractic Billing

 

Chiropractic Manipulative Treatment (CMT) is a hands-on therapeutic procedure used by chiropractors to improve spinal alignment, restore joint function, and relieve nerve pressure. It’s especially effective for treating neck pain, back pain, headaches, and musculoskeletal issues. To ensure accurate billing and compliance, chiropractors must understand and correctly use CPT codes that correspond to the number of spinal regions treated during a session.

This blog breaks down CPT codes 98940, 98941, and 98942, outlines Medicare billing rules, documentation best practices, and offers a solution for streamlined chiropractic billing.

Understanding CPT Codes for CMT

CPT Code 98940
Used when one or two spinal regions are treated. This might include the cervical and lumbar areas for neck and lower back pain or cervical and thoracic for headaches and upper back discomfort.

CPT Code 98941
Applies when three or four spinal regions are manipulated during a session. Common in cases involving widespread spinal issues, such as neck, mid-back, and lower back pain.

CPT Code 98942
Used when all five spinal regions—cervical, thoracic, lumbar, sacral, and pelvic—are adjusted. This is usually associated with complex cases like post-trauma care or chronic spinal conditions.

Medicare Guidelines for Chiropractic Billing

Medicare imposes specific regulations for chiropractic services:

• CMT Services Only: Medicare covers only spinal manipulation for subluxation. Services like massage therapy, exercises, or ultrasound are not reimbursed under Medicare Part B.
• Subluxation Diagnosis Required: Claims must include a diagnosis of spinal subluxation, verified either by imaging or detailed clinical examination findings.
• Use of AT Modifier: When the service is part of active treatment, the AT modifier must be appended to the CPT code. Without it, the claim is considered maintenance care and will be denied.
• Maintenance Care Not Covered: Treatments solely for symptom prevention or condition maintenance are not eligible for Medicare reimbursement.
• Advance Beneficiary Notice (ABN): When non-covered services are rendered, an ABN must be issued to inform the patient that they are financially responsible.

Essential Documentation for Compliance

Accurate documentation is key to successful reimbursement. Chiropractors must:

• Conduct a Pre-Manipulation Assessment that reviews the patient's symptoms and history.
• Record Objective Findings such as examination results, subluxation indicators, or imaging.
• Include an Accurate Diagnosis linking the condition to the number of spinal regions treated.
• Outline a Treatment Plan with session frequency, targeted areas, and clinical goals.
• Track Patient Progress at each visit, noting improvements or reasons for unchanged symptoms.

Following the SOAP format (Subjective, Objective, Assessment, Plan) is highly recommended for visit notes to establish medical necessity and continuity of care.

Common Chiropractic Billing Mistakes to Avoid

Even small documentation or coding errors can result in denials or delayed payments. Common pitfalls include:

• Missing Subluxation Evidence: Without objective data backing the diagnosis, claims are at risk.
• Neglecting ABNs: Failing to issue an ABN before providing non-covered services means you cannot bill the patient.
• Vague Visit Notes: Avoid general statements; be specific and tie findings directly to the CPT code selected.

Why Consider Outsourcing Chiropractic Billing?

Managing compliance, documentation, and reimbursement challenges in-house can be time-consuming and costly. Offshore chiropractic billing and coding companies provide scalable support to ensure error-free coding, proper modifier usage, and fast claim processing.

At Info Hub Consultancy Services (ICS), we offer specialized RCM support tailored to chiropractic practices. As a trusted outsourcing Medical billing & coding service provider in India, our certified experts deliver end-to-end billing and coding services with deep knowledge of chiropractic coding guidelines and Medicare rules. With ICS, practices reduce denials, accelerate cash flow, and regain focus on patient care.

FAQs

Q: Can CPT codes 98940 – 98942 be billed for pediatric patients?
A: Yes, if medical necessity is clearly documented. Age doesn’t limit use.

Q: Are these CPT codes used for initial or follow-up visits?
A: They apply to both, as long as spinal manipulation is performed.

Q: Can multiple CPT codes from 98940 – 98942 be billed in one session?
A: No. Only one code representing the total spinal regions treated should be billed per visit.

Q: Are these codes time-based?
A: No. Billing is based on the number of spinal regions treated, not the time spent.

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