Chiropractic CPT codes, or Current Procedural Terminology codes are an expansive set of codes published and maintained by the American Medical Association (AMA). As with ICD-10, CPT codes are an important set of codes for chiropractors and chiropractic billing specialists to become familiar with. Billing with incorrect chiropractic CPT codes can lead to claim rejections and delays in payments, and put your practice at risk for failure. It’s hard for any chiropractor to keep their doors open if they don’t have the cash flow to cover their operating costs.
What Are Chiropractic CPT Codes
Chiropractic CPT codes are used to describe various procedures performed by chiropractors on a patient. These codes can be used to describe chiropractic exams, adjustments, imaging studies performed in the office and more. Although the overall code set is extremely large and includes codes for tens of thousands of procedures, most chiropractors bill using a limited number of these CPT codes.
Commonly Used Chiropractic CPT Codes by Chiropractors
Unlike medical practitioners, chiropractors use a limited set of CPT codes. The most commonly used chiropractic CPT codes are those related to chiropractic manipulative treatment or chiropractic adjustments. There are only four codes for chiropractic manipulation, each of which is based on the spinal regions treated.
Most Frequently Used Chiropractic CPT Codes by Chiropractors
CPT Code 98940 Chiropractic manipulative treatment (CMT); spinal, 1-2 regions
CPT Code 98941 Chiropractic manipulative treatment (CMT); spinal, 3-4 regions
CPT Code 98942 Chiropractic manipulative treatment (CMT); spinal, 5 regions
CPT Code 98943 Chiropractic manipulative treatment (CMT); extraspinal, 1 or more regions
Medicare Covered Chiropractic Services
Medicare coverage extends only to treatment by means of manual manipulation of the spine to correct a subluxation. No other diagnostic, office visit or therapeutic services provided by a chiropractor or under a chiropractor’s order is covered by Medicare. The only CPT codes that should be billed to Medicare are CPT Code 98940, CPT Code 98941, and CPT Code 98942. Medicare does not cover CPT Code 98943.
Chiropractic CPT Codes, Chiropractic ICD-10 codes and the AT Modifier
If the Chiropractic CPT code is 98940, 98941, or 98942 AND is billed with one of the following primary diagnosis codes (ICD-10 codes) AND with modifier AT, then the chiropractic service is covered by Medicare.
M99.00 Segmental and somatic dysfunction of head region
M99.01 Segmental and somatic dysfunction of cervical region
M99.02 Segmental and somatic dysfunction of thoracic region
M99.03 Segmental and somatic dysfunction of lumbar region
M99.04 Segmental and somatic dysfunction of sacral region
M99.05 Segmental and somatic dysfunction of pelvic region
M99.10 Subluxation complex (vertebral) of head region
M99.11 Subluxation complex (vertebral) of cervical region
M99.12 Subluxation complex (vertebral) of thoracic region
M99.13 Subluxation complex (vertebral) of lumbar region
M99.14 Subluxation complex (vertebral) of sacral region
M99.15 Subluxation complex (vertebral) of pelvic region
M99.20 Subluxation stenosis of neural canal of head region
M99.21 Subluxation stenosis of neural canal of cervical region
M99.22 Subluxation stenosis of neural canal of thoracic region
M99.23 Subluxation stenosis of neural canal of lumbar region
S13.100A Subluxation of unspecified cervical vertebrae, initial encounter
S13.110A Subluxation of C0/C1 cervical vertebrae, initial encounter
S13.120A Subluxation of C1/C2 cervical vertebrae, initial encounter
S13.130A Subluxation of C2/C3 cervical vertebrae, initial encounter
S13.140A Subluxation of C3/C4 cervical vertebrae, initial encounter
S13.150A Subluxation of C4/C5 cervical vertebrae, initial encounter
S13.160A Subluxation of C5/C6 cervical vertebrae, initial encounter
S13.170A Subluxation of C6/C7 cervical vertebrae, initial encounter
S13.180A Subluxation of C7/T1 cervical vertebrae, initial encounter
S23.100A Subluxation of unspecified thoracic vertebra, initial encounter )
S23.110A Subluxation of T1/T2 thoracic vertebra, initial encounter
S23.120A Subluxation of T2/T3 thoracic vertebra, initial encounter
S23.122A Subluxation of T3/T4 thoracic vertebra, initial encounter
S23.130A Subluxation of T4/T5 thoracic vertebra, initial encounter
S23.132A Subluxation of T5/T6 thoracic vertebra, initial encounter
S23.140A Subluxation of T6/T7 thoracic vertebra, initial encounter
S23.142A Subluxation of T7/T8 thoracic vertebra, initial encounter
S23.150A Subluxation of T8/T9 thoracic vertebra, initial encounter
S23.152A Subluxation of T9/T10 thoracic vertebra, initial encounter
S23.160A Subluxation of T10/T11 thoracic vertebra, initial encounter
S23.162A Subluxation of T11/T12 thoracic vertebra, initial encounter
S23.170A Subluxation of T12/L1 thoracic vertebra, initial encounter
S33.100A Subluxation of unspecified lumbar vertebra, initial encounter
S33.110A Subluxation of L1/L2 lumbar vertebra, initial encounter
S33.120A Subluxation of L2/L3 lumbar vertebra, initial encounter
S33.130A Subluxation of L3/L4 lumbar vertebra, initial encounter
S33.140A Subluxation of L4/L5 lumbar vertebra, initial encounter
Most Commonly Billed CPT Codes to Commercial Payers
CPT Code 99202 – Evaluation and Management, Initial Visit
CPT Code 99203 – Evaluation and Management, Initial Visit
CPT Code 99204 – Evaluation and Management, Initial Visit
CPT Code 99212 – Evaluation and Management, Established Patient
CPT Code 99213 – Evaluation and Management, Established Patient
CPT Code 99214 – Evaluation and Management, Established Patient
CPT Code 97140 – Manual Therapy
CPT Code 97110 – Therapeutic Exercise
CPT Code 97750 – Physical Performance Examination
CPT Code 99211 – Re-evaluation
CPT Code 97112 – Neuromuscular Re-education
CPT Code 97530 – Therapeutic Activities
CPT Code 97010 – Hot/Cold Packs
CPT Code 97014 – Electrical Stimulation (Unattended)
CPT Code 97035 – Ultrasound/Phonophoresis
CPT Code 97161 – PT Evaluation: Low Complexity
CPT Code 97116 – Gait Training
CPT Code 97162 – PT Evaluation: Moderate Complexity
CPT Code 97535 – Self Care/Home Management Training
CPT Code 97032 – Electrical Stimulation (Manual)
CPT Code 97012 – Mechanical Traction
CPT Code 97113 – Aquatic Exercise
CPT Code 97124 – Massage
CPT Code 97018 – Paraffin Bath
CPT Code 97022 – Whirlpool
CPT Code 97026 – Infrared Light
CPT Code 97033 – Iontophoresis
CPT Code 97039 – Laser/Other
CPT Code 72020 – Radiologic examination, spine, single view, specify level
CPT Code 72040 – Radiologic examination, spine, cervical; two or three views
CPT Code 72070 – Radiologic examination, spine; thoracic, two views
CPT Code 72072 – Radiologic examination, spine; thoracic, three views
CPT Code 72100 – Radiologic examination, spine, lumbosacral; two or three views
CPT Code 72170 – Radiologic examination, pelvis; one or two views
CPT Code 72190 – Radiologic examination, pelvis; complete, minimum of three views
CPT Code 72200 – Radiologic examination, sacroiliac joints; less than three views
CPT Code 72220 Radiologic examination, sacrum and coccyx; minimum of two views
Chiropractic Claim Rejections vs Claim Denials
Insurance claim denials and rejections are one of the biggest obstacles affecting chiropractic reimbursements.
Rejected Claims are claims that do not meet specific data requirements or basic formatting that are rejected by insurance according to the guidelines set by the Centers for Medicare and Medicaid Services. These errors can be as simple as a transposed digit from the patient’s insurance ID number, an incorrect chiropractic CPT code, or an incorrect modifier. Rejected claims are sent back to the chiropractor, with an explanation of why it was rejected. You then have the opportunity to correct the CPT code and resubmit the claim. The process of rectifying the error delays payments and can negatively affect your practice’s cash flow.
Denied claims are altogether a different issue. The Payer determines that the claim is not payable. These claims are also returned, with an explanation for the denial. There is an appeals process for denied claims. If you resubmit this type of claim without an appeal or reconsideration request it will most likely be denied as a duplicate, costing you even more time and money the claim remains unpaid.
How to Reduce Claim Rejections and Denial Rates
Medical claim denials and rejections are perhaps the most significant challenge for a chiropractor’s practice. They have a negative impact on practice revenue and the billing department’s efficiency. Educating your billing staff and collecting and analyzing claim data can determine trends in denials and rejections. Using up-to-date software or outsourcing your billing to an experienced chiropractic billing service can also prove invaluable.
How ChiroFusion Can Help With Chiropractic CPT Codes and Billing
ChiroFusion’s chiropractic billing software and chiropractic billing services make it easy to manage your billing. Through our integrated system, billers can link CPT codes directly from the provider’s SOAP notes, preventing the use of erroneous codes. If your in-house billing staff is struggling with claim rejections and denials, and growing accounts receivables, our chiropractic billing service is a great solution for your practice.
Contact ChiroFusion today and find out how our experienced team of coders and billers can help to resolve your billing problems and increase your profitability.
Selected References:
Chiropractic billing rules for CPT 97140 – Manual therapy techniques.
Medicare rules and coding guidelines for chiropractic.
Chiropractic billing proper use of E/M CPT codes 99201-99204.
Chiropractic CPT procedural codes – ASH.
CMT coding guidelines for chiropractic.
Chiropractic riders: procedure codes and coverage codes.