Chiropractic Manipulative Treatment is a hands-on therapy used by chiropractors to improve joint movement, correct spinal alignment, and reduce nerve interference. The treatment involves applying controlled force to specific joints, most often in the spine, to restore proper motion and function.

CMT plays an important role in patient care by helping reduce pain, improving mobility and supporting recovery from musculoskeletal conditions. It is commonly used to treat back pain, neck pain, headaches, and other joint-related issues, promoting overall physical well-being. To ensure correct billing and payment for these services, chiropractors must use the proper CPT codes, which reflect the exact number of spinal regions treated during a session.

This blog will provide a clear and detailed explanation of CPT codes 98940, 98941 and 98942 to help chiropractors achieve accurate billing and compliance.

Overview of CPT Codes for Accurate Chiropractic Billing

• CPT Code 98940: CMT of 1 – 2 spinal regions

CPT code 98940 is used when a chiropractor performs spinal manipulation on one or two spinal regions during a single session. It is typically selected for localized pain or injury, such as adjusting the cervical and lumbar areas for neck pain and lower back discomfort, or the cervical and thoracic regions for tension headaches and mid-back stiffness.

• CPT Code 98941: CMT of 3 – 4 spinal regions

CPT code 98941 applies when three or four spinal regions are adjusted in one visit. It is often used for cases involving more widespread spinal issues such as neck tension, mid-back discomfort and lower back pain requiring adjustments to the cervical, thoracic, and lumbar areas, or including the sacral region for posture-related concerns.

• CPT Code 98942: CMT of 5 spinal regions

CPT code 98942 is selected when all five spinal regions – cervical, thoracic, lumbar, sacral, and pelvic – are adjusted during the same session. This is generally used for complex cases such as post-accident recovery or conditions causing stiffness and pain throughout the spine.

Medicare Rules for Chiropractic Billing

Medicare has specific rules for paying chiropractors, especially for Chiropractic Manipulative Treatment billed under CPT codes 98940, 98941, and 98942.

• Medicare Covers CMT Only

Medicare only pays when the treatment is active care for spinal manipulation to correct a subluxation. Any other services that chiropractors may provide such as massage therapy, acupuncture, exercises, or therapeutic modalities are not covered under Medicare Part B, even if they are given during the same visit.

• Requirement for Subluxation Diagnosis

To be covered, the claim must include a spinal subluxation diagnosis. This can be shown through an X-ray taken within a reasonable period or by using specific examination findings that meet Medicare’s definition of subluxation.

• AT Modifier Requirement

When the treatment is active and corrective, chiropractors must add the AT modifier to the CPT code. Without this modifier, Medicare will treat the service as maintenance care and deny payment.

• Maintenance Care Not Covered

Medicare does not pay for treatment that is only to maintain a patient’s current condition or prevent symptoms from returning. Even if spinal manipulation is performed, this type of care is not reimbursable.

• Services Medicare Does Not Cover

Some services are excluded from coverage, even if provided during a covered CMT visit. A few of the examples include:

• Extraspinal manipulation covered by CPT 98943
• Ultrasound therapy
• Therapeutic exercises
• Electrical stimulation

When these are provided, the patient must be informed that they are non-covered and billed directly.

• Advance Beneficiary Notice (ABN)

If a chiropractor provides a non-covered service during the same visit as a covered CMT, an ABN must be given to the patient. This form explains that the patient will be financially responsible for the service.

Documentation Requirements for Compliance

To get paid for CPT codes under Medicare, records must be complete and clearly prove the treatment was medically necessary. The notes should connect the patient’s condition, the diagnosis, and the number of spinal regions treated.

1. Key Elements to Document

• Pre-Manipulation Assessment

Before any CMT is performed, the chiropractor must conduct and document an initial assessment. This includes reviewing the patient’s history, symptoms and previous treatments to determine whether CMT is appropriate.

• Objective Findings

The records must include objective evidence of spinal subluxation and related conditions. This can be documented through physical examination findings, orthopedic or neurological tests, and when necessary, imaging reports.

• Diagnosis

The primary diagnosis must be a spinal subluxation, as required by Medicare, along with any supporting secondary diagnoses. The chosen CPT code (98940, 98941, or 98942) must match the number of spinal regions identified in the diagnosis.

• Treatment Plan

The treatment plan should clearly outline the frequency and duration of CMT sessions, the specific spinal regions being treated, and the therapeutic goals. The plan must align with the patient’s diagnosis and expected recovery progress.

• Patient Progress and Response

Each visit should include updates on the patient’s progress, such as reduced pain, improved mobility, or ongoing symptoms. If no improvement is noted, documentation should state the reason and any planned changes in treatment.

2. SOAP Notes Best Practices

Follow the SOAP format for each treatment visit:

S – Subjective: Patient’s description of pain, discomfort, or functional problems.

O – Objective: Physical exam findings, test results, or other measurable data.

A – Assessment: Professional judgment of the patient’s condition and need for continued care.

P – Plan: The treatment provided that day and the plan for future visits.

Common Billing Mistakes and How to Avoid Them

Even experienced chiropractors can face claim denials or payment delays if documentation and coding requirements are not strictly followed. Below are the most common mistakes in chiropractic billing with practical ways to prevent them-

• Incomplete Subluxation Documentation

Medicare coverage depends on a documented primary diagnosis of spinal subluxation supported by imaging or detailed physical exam findings. Denials occur when objective findings are missing or when the connection between diagnosis and treatment is unclear. Thoroughly recording pre-treatment findings, relevant orthopedic or neurological test results, and linking them directly to the number of treated spinal regions ensures claims meet the necessary standard.

• Not Issuing an ABN for Non-Covered Services

Services not covered by Medicare require an Advance Beneficiary Notice (ABN) to bill the patient directly. If this step is missed, reimbursement cannot be collected from the patient. Providing an ABN before delivering non-covered services and keeping the signed form in the patient’s file protects both the provider and the patient from billing disputes.

• Poorly Maintained Treatment Notes

Vague or incomplete visit notes – especially those not following SOAP (Subjective, Objective, Assessment, Plan) format – make it challenging to justify medical necessity. It is crucial to use SOAP notes with specific symptom updates, measurable exam findings, and clearly defined treatment plans aligned to patient progress consistently. This ensures that documentation supports both compliance and reimbursement.

Outsourcing Chiropractic Billing & Coding Services as a One-Stop Solution

Offshore chiropractic billing and coding companies provide an all-in-one solution that streamlines your chiropractic billing process. These specialized teams ensure accurate coding, proper modifier usage and thorough documentation compliance. In fact, chiropractic practices can minimize claim denials and accelerate reimbursements by leveraging their expertise.

InfoHub Consultancy Services stands out as a trusted outsourcing Medical billing & coding service provider in India for providers seeking reliable offshore billing solutions. With a deep understanding of industry-specific regulations and a commitment to precision, our team ensures every claim is handled with care and expertise. Our dedicated team not only improves revenue cycle efficiency but also provides personalized support tailored to the unique needs of each practice.

FAQs

Q: Can CPT codes 98940 – 98942 be billed for pediatric patients?

Ans: But documentation must support medical necessity regardless of patient age.

Q: Are these CPT codes used for initial or follow-up chiropractic visits?

Ans: They apply to both, as long as manipulative treatment is performed.

Q: Can multiple CPT codes from 98940 – 98942 be billed in the same session?

Ans: Only one code reflecting the total regions treated should be billed per visit.

Q: Are there specific time requirements associated with these CPT codes?

Ans: Billing is based on regions treated, not time spent.

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