In chiropractic billing, using the correct CPT codes are crucial for ensuring that services are accurately reimbursed. One of the CPT (Current Procedural Terminology) codes that chiropractors use often is 98941 CPT code. This blog will explore when to use 98941 procedure code, challenges, benefits, and documentation requirements associated with this billing code.

What is CPT Code 98941?

98941 CPT code definition by American Academy of Professional Coders states that this code should be used to report chiropractic manipulative treatment (CMT) performed on 3-4 spinal regions by a qualified chiropractor.

The code describes the manual manipulation techniques used by providers to correct subluxations and enhance the alignment and function of the spine. Chiropractors use this treatment to:

© All Current Procedural Terminology (CPT) codes and descriptors are copyrighted 2024 by the American Medical Association.

Who Can Apply Mechanical Traction in Chiropractic Office?

Usually, chiropractors apply mechanical traction, some states in the US also allow staff members, such as trained Chiropractic Assistant, to assist with mechanical traction. It is important to check with your state laws for the scope of practice when it comes to applying mechanical traction.

It is important to note that the provider must be present in the office when a Chiropractic Assistant performs these therapies, but it is not necessary for the provider to be in the same room where the patient is being treated with mechanical traction.

Challenges of Using CPT Code 98941

While 98941 chiropractic code is valuable for chiropractors to report a manipulation service to spinal regions 3-4, it comes with several challenges:

 Insurance Reimbursement:

• 98941 code requires hands-on treatment. The use of this CPT code must reflect this.
• Payers often scrutinize these codes more closely and may require you to provide medical necessity and

 Detailed Documentation:

• Utilizing CPT 98041 requires thorough and precise documentation. Chiropractors must provide comprehensive descriptions of the services rendered, the clinical rationale for using the code, and evidence of medical necessity. This can be time-consuming and may necessitate additional administrative resources.

 Use of Other Codes with 98941

• Another challenge is ensuring that CPT 98941 is used alongside other appropriate codes. For instance, if a patient requires an X-ray or other diagnostic tests, these should be billed separately with their respective codes.

98941 CPT Code Reimbursement

98941 Cat code reimbursement is subject to variation based on the insurance payers and specific policies in place. 

Medicare coverage of chiropractic services is specifically limited to treatment by means of manual manipulation of the spine to correct a subluxation.

Chiropractors are limited to billing 98940, 98941 and 98942 under Medicare. Medicare does not cover chiropractic treatment to extraspinal regions (CPT Code 98943).

2024 Kentucky Part B Physician Fee Schedule for 98941

# – These amounts apply when service is performed in a facility setting.

 As a chiropractic service provider, you need to check the specific guidelines by insurance payers and check their reimbursement policies to determine the exact reimbursement for this code. 

Optimizing Reimbursement for 98941 CPT Code

To maximize reimbursement for 98941, chiropractors should follow specific guidelines and strategies. These guidelines ensure accurate reporting, proper documentation, and appropriate reimbursement for chiropractic manipulative treatment. Adhering to Medicare and other insurance payers’ standards is crucial to avoid claim denials and potential audits.

1. Document the Need for Treatment:

Clearly document the patient’s condition and the necessity for chiropractic manipulative treatment. Explain the symptoms, functional limitations, and other relevant factors supporting the treatment’s medical necessity.

2. Specify the Regions Treated:

Clearly indicate which spinal regions were treated using 98941 chiropractic code. Document the specific vertebrae or areas targeted during the treatment to ensure accurate coding and billing.

3. Provide Evidence of Medical Necessity:

Include supporting evidence, such as diagnostic tests, imaging results, or previous treatments, to justify the medical necessity of the chiropractic manipulative treatment. This documentation helps validate the need for the specific CPT code used.

4. Use Appropriate Modifier Codes:

When necessary, use modifier codes to provide additional information about the service provided. This can help clarify the context of the treatment and improve the likelihood of reimbursement.

5. Regularly Review Payer Policies:

Stay updated with the latest guidelines and policies from Medicare and other insurance payers. Regularly review these policies to ensure compliance and adjust billing practices accordingly.

6. Educate Patients on Coverage:

Educate patients about their insurance coverage for chiropractic services. Clear communication with patients can help manage their expectations and reduce potential billing issues.

7. Maintain Detailed Patient Records:

Keep comprehensive and detailed records of patient visits, treatments, and outcomes. This not only supports the medical necessity but also provides a robust defence in case of audits.

8. Submit Clean Claims:

Ensure that claims are complete and accurate before submission. Double-check for errors or omissions that could lead to denials or delays in reimbursement.

9. Engage in Continuous Education:

Participate in ongoing education and training related to chiropractic billing and coding. Staying informed about changes and best practices can help improve reimbursement rates.

10. Collaborate with Billing Experts:

Consider working with chiropractic billing specialists or services that have expertise in billing and coding. Their knowledge and experience can enhance the accuracy and efficiency of your billing process.

Conclusion

98941 billing code represents the specific treatment of 3-4 spinal regions and is commonly used in the management of musculoskeletal disorders. Proper documentation and adherence to payer guidelines are vital for successful reimbursement.

By implementing the reimbursement strategies can help chiropractors effectively use 98941 procedure code, justify the treatment provided, and ensure accurate and timely reimbursement.

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