Chiropractic codes are an integral part of the chiropractic billing and coding process. Using the chiropractic CPT codes accurately can streamline coding practices and improve your revenue cycle. Because CPT codes directly affect how much an insurance company will reimburse for chiropractic services, practices need to be careful about how coding is done. In this blog, we will tell you the most common chiropractic CPT codes and how you can analyze your CPT codes for chiropractic consultation to identify patterns.
What are Chiropractic CPT Codes?
Current Procedural Terminology (CPT) codes are managed, reviewed, and monitored by the American Medical Association. CPT codes for chiropractors are used to report diagnostic procedures and services and describe chiropractic examinations, adjustments, and imaging studies.
Insurance companies use chiropractic billing codes to determine the reimbursement amount for a procedure performed by a provider. Billing with an incorrect CPT code for chiropractic services can result in claim denials or rejections. There are chiropractic CPT codes for billing tens of thousands of procedures. Therefore, it is important to understand the coding best practices and how you can streamline your coding and billing workflow.
There are several categories of CPT chiropractic codes, including:
Category I: Procedures, services, devices, and drugs, including vaccines
Category II: Performance measures and quality of care
Category III: Services and procedures using emerging technology
There are also PLA codes that are alpha-numeric CPT codes used for lab testing.
Category I CPT codes for chiropractic, which are the most commonly used category among healthcare providers, are grouped into six broad sections as follows:
• Evaluation and Management: Codes starting from 99201 to 99499
• Anesthesia: Codes 00100–01999; 99100–99140
• Surgery: Codes starting from 10021 to 69990
• Radiology: Codes starting from 70010 to 79999
• Pathology and Laboratory: Codes starting from 80047 to 89398
• Medicine: Codes starting from 90281–99199; 99500–99607
The Most Common Chiropractic CPT Codes Used for Billing
Chiropractic providers use a wide range of CPT codes for chiropractic services but the most common ones are related to spinal manipulation:
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
When billing these CPT codes for chiropractic maintenance, all treatment procedures should be categorized as maintenance therapy, chronic subluxation, or acute subluxation.
Chiropractic CPT Codes List
Here is a list of the other most commonly used CPT codes for chiropractic care when billing insurance companies:
• 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 97012 – Mechanical Traction
Here is a list of the other most commonly used CPT codes for chiropractic evaluation:
• 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 99211 – Re-evaluation
Changes for Chiropractic CPT Codes in 2023: What You Need to Know
In 2023, things are changing in chiropractic care. When chiropractors help patients, they need to make sure their services match the patient’s needs and are medically necessary. This is important for billing correctly.
Also, only the direct services given directly to patients can be billed. This means if a patient or someone without special training helps, or if a person in the office helps without a licensed provider’s supervision, it won’t be counted as professional therapy.
2023 code updates are especially important for services like taking care of people in hospitals, and emergencies, talking with other doctors for advice, and helping people in nursing homes.
So, the way doctors and care teams code things has become simpler, which helps the people who handle billing for chiropractic care.
These changes are part of 393 edits made to the 2023 chiropractic CPT codes list. This set of chiropractic therapy CPT codes describes different medical procedures and services, and it’s always getting better as health technology and medical science improve.
For chiropractic services, some important CPT codes for chiropractic care are 98940-98943. If you’re in charge of billing, here are some things to remember:
- Tell what you did in the first treatment.
- If you did an X-ray, say when you did it and show the X-ray picture.
- If you didn’t do an X-ray, a doctor’s check-up can be used to show what’s wrong.
- Use a special code for the problem you’re treating.
- Put treatments into groups like keeping things going well, treating a long-standing problem, or a new problem.
Your team should use codes 98940, 98941, and 98942 to show exactly how you worked on people’s joints and nerves to help them feel better.
If you’re using chiropractic billing software, you can easily create reports to view the most frequently used CPT codes for chiropractic consultation and evaluation you provide in your practice. This will help you to discover the patterns in the types of conditions your patients have and uncover their therapeutic needs. Once you know the most common chiropractic CPT codes you use, you can create code favorites in your chiropractic EHR and billing software. It will help you speed up the process of coding while creating an invoice.
Tips to Perfect Your Chiropractic Billing Codes
1. Verify your patients’ insurance eligibility. You may provide the same types of treatment to two patients having different insurance plans. You might get reimbursed for one claim and get rejected for the second claim. Make sure to check the insurance coverage of the patient before providing treatment or billing his or her insurance company.
2. Prioritize completing pre-authorizations before commencing treatment (if applicable). Even if a patient has chiropractic benefits in their plan, claims may still be denied if pre-authorization requirements are not met. To avoid such issues, ensure that all necessary pre-authorizations are in place before starting any treatment.
3. Chiropractors should rarely bill 99211 as this CPT chiropractic code is used for established patient code that does not require the presence of a provider or other qualified healthcare professional. Also, make sure when submitting claims to Medicare, you don’t include services other than manual manipulation of the spine for treatment of subluxation of the spine. Chiropractic offices may want to submit charges to Medicare to obtain a denial necessary for submitting to a secondary insurance carrier. The following are examples of (not an all-inclusive list) services that, when performed by a Chiropractor, are excluded from Medicare coverage, including Laboratory tests, X-rays, Office Visits (history and physical), Physiotherapy, Traction, Supplies, Injections, Drugs, Diagnostic studies including EKGs, Acupuncture, Orthopedic devices, and Nutritional Supplements and Counseling.
4. Chiropractors are limited to billing three CPT codes for chiropractic services under Medicare including 98940 (chiropractic manipulative treatment; spinal, one to two regions), 98941 (three to four regions), and 98942 (five regions). Providers must use correct chiropractic codes and modifiers when billing Medicare. You must add an Acute Treatment (AT) modifier when reporting Chiropractic Therapy CPT codes – 98940, 98941, and 98942.
5. If your selected chiropractic CPT codes for billing require a modifier and you fail to include them, your claim will be rejected by the insurance company. Make sure you know the correct combinations of chiropractic codes and modifiers for each treatment you provide. Note that most of the billed codes are chiropractic adjustment CPT codes and submission of appropriate diagnosis codes and documents helps in correct reimbursement. When submitting a CPT code for chiropractic manipulation to Medicare, you must include the Acute Treatment (AT) modifier if you expect to get paid.
6. Modifier 25 is the most commonly used modifier with chiropractic procedure codes. Modifier 25 should be used when an Exam is performed on the same day as an adjustment. Insurance companies typically pay for both exams AND the adjustment when you include Modifier 25 to these exam codes (99201-99205/99211-99215).
7. Modifier 59 is another modifier code used in chiropractic practices. It is used to identify procedures and services other than E/M services. Remember, there are subsets of Modifier 59 including Modifier XE (Separate encounter), Modifier XS (Separate structure), Modifier XP (Separate practitioner), and Modifier XU (Unusual non-overlapping service).
8. Having an integrated EHR and billing solution is beneficial for your insurance billing process. You can quickly refer to SOAP notes when creating an invoice.
9. Review your insurance contracts. Practices need to take time to review their contracts with payers to understand if there were any changes from the previous year. This will allow them to find the changes in the chiropractic billing codes that are covered or not covered by the payer and accommodate a change in workflow and processes.
10. Each CPT code for chiropractic care corresponds to a specific number of regions, regardless of the number of manipulations performed in that region. For instance, if chiropractic manipulation is applied to both C3 and C5 during the same visit, it represents treatment to only one region (cervical) and should be reported with CPT code for chiropractic manipulation – 98940.
All CPT codes for Chiropractic Manipulative Treatment (CMT) require a supporting ICD-10-CM diagnosis code to justify the level of care provided. For example, when billing the CPT code for chiropractic – 98941, there must be ICD-10-CM codes that incorporate at least three different regions to support the treatment provided.
Chiropractic Billing – Mistakes to Avoid
Mistakes such as incorrect CPT chiropractic codes can lead to claim rejections and delays in payments and put your practice at risk for failure. Avoid these errors to boost your revenue:
- Analyze your denied claims. Analyzing and identifying the denied claim is important as it helps you understand which chiropractic procedure codes were denied by the payer and if the beneficiaries are being treated outside their networks without their knowledge, etc.
- Any errors in the patient data, providers’ eligibility, and patients’ insurance information may lead to the loss of full payment. That’s why verification is important for reimbursement because it ensures that everything is recorded as it should be.
- Reduce your accounts receivables. Separate all account receivables by patient balances and insurance. Another way is to set apart different payers’ insurance and have the know-how of their specific guidelines that affect the receivable management of your accounts.
- Collect patient balances. To collect copays or coinsurances, have an integrated payment processing system.
- When using Medicare billing codes for chiropractic, providers must place an AT modifier on a claim if they are providing active/corrective treatment to treat acute or chronic subluxation.
- Medicare does not cover chiropractic treatments to extraspinal regions (CPT 98943), which includes the head, upper and lower extremities, rib cage, and abdomen.
- According to the guidelines around using Medicare billing codes for chiropractic, manual devices (i.e., those that are handheld with the thrust of the force of the device being controlled manually) may be used by providers in performing manual manipulation of the spine. However, no additional payment is available for the use of the device, nor does Medicare recognize an extra charge for the device itself.
- Whenever you are going to bill Medicare and private insurance payers, make sure all documentation is complete and you have followed the guidelines for the correct usage of the chiropractic insurance billing codes.
- According to the coding document by Blue Cross Blue Shield (BCBS), it is not appropriate to bill for multiple time-based codes, such as several manual therapies (CPT 97140), when Chiropractic Manipulative Treatment (CMT) was the only service provided. The CMT CPT® code should not be replaced with another CPT code for chiropractic treatment if CMT was the actual service performed. It is essential to use the CPT codes for chiropractic care that accurately describe the services rendered.
- BCBS states that using an Evaluation and Management (E/M) code instead of a Chiropractic Manipulative Treatment (CMT) code to bypass limits on CMT is not appropriate. It is necessary to bill CPT chiropractic codes that accurately reflect the services provided. The correct code should always be used to describe the service rendered.
- When billing Medicare, the precise level of subluxation must be specified on the claim. It must be listed as the primary diagnosis. The neuromusculoskeletal condition necessitating the treatment must be listed as the secondary diagnosis. Use accurate chiropractic diagnosis codes for Medicare to specify primary and secondary diagnoses.
- Make sure your chiropractic diagnosis codes match with the appropriate chiropractic CPT codes in order to prove medical necessity.
Benefits of zHealth for Chiropractic Insurance Billing
Using incorrect chiropractic CPT codes for billing and an inadequate billing process can affect the finances of a chiropractic business. To overcome this problem, chiropractors need to automate insurance billing and coding. With zHealth billing software, chiropractic providers can:
• Maintain the accuracy of CPT codes for chiropractic services
• Generate structured invoices and billing statements
• Create and submit clean claims with accurate CPT codes for chiropractors
• Store credit card information to charge or invoice for copays
• Create superbills and submit HCFA forms electronically
• Generate billing reports and A/R reports
Chiropractors also employ professional billers or hire managed billing services to ensure chiropractic procedures are coded correctly. Hiring managed billing services helps them streamline the insurance billing process and dedicate more time toward patient care. At zHealth, we can effectively handle all your chiropractic billing needs and claim settlements. For more information call us at +1-800 674-2908.
