Chiropractic CPT codes are crucial in chiropractic insurance billing, where specific treatments and services must be precisely coded for proper reimbursement. There are four commonly used CPT codes, including 98940, 98941, 98942, and 98943. We have created detailed articles on how and when to use CPT codes 98940, 98941 and 98942.

CPT Code 98943, which covers extremity manipulative treatments. While spinal manipulations are often the focus of chiropractic work, extremity adjustments play a significant role in patient care and should be billed accordingly. In this blog, we’ll check out what CPT code 98943 is, its uses, the challenges associated with it, documentation requirements, and important tips for using it correctly to maximize your practice’s efficiency.We will explore the impact of CPT Code 98943 on your practice’s billing efficiency and how it can lead to better financial outcomes

What is the CPT Code 98943?

CPT code 98943 is used to bill for chiropractic manipulative therapy (CMT) that extends beyond the spine, such as hands, legs, feet, etc. It specifically covers the chiropractic adjustment of extraspinal regions. These include:

• Extremities like the arms, legs, hands, feet, shoulders, and hips
• Jaw (TMJ), ribs, or other areas outside the spine

Chiropractors typically use CPT 98943 when addressing issues in these areas, such as joint pain or dysfunction in the shoulders, knees, or hips, alongside regular spinal adjustments.

According to BCBS, the 98943 CPT code description is – “CMT code 98943 is used to report chiropractic manipulation of one or more of the extra-spinal regions (head region; lower extremities; upper extremities; rib cage; abdomen).”

The five extraspinal regions are: head (including temporomandibular joint, excluding altanto-occipital) region; lower extremities; upper extremities; rib cage (excluding costotransverse and costovertebral joints) and abdomen.

When to Use 98943 Chiropractic Code

98943 procedure code is used when a chiropractor performs manual manipulative treatment of an extremity or extraspinal area. It’s commonly used in conjunction with spinal adjustment codes (CPT codes 98940-98942), allowing chiropractors to bill for a full scope of treatment services. For example:

• Treating shoulder pain alongside neck and back issues
• Addressing knee pain or dysfunction along with a lumbar spine adjustment

Importance of Understanding the Code for Effective Billing

Understanding the 98943 CPT code definition is essential for any chiropractor who wants to ensure accurate billing. When properly applied, this code reflects the full extent of care provided, leading to accurate reimbursements from insurers. Failing to use this code, or using it incorrectly, can lead to underbilling or claim denials, both of which negatively impact practice revenue.

Please note that Medicare does not cover chiropractic treatment to extraspinal regions (98943) which includes the head, upper and lower extremities, rib cage and abdomen.

Challenges of Using CPT Code 98943

Though CPT 98943 can enhance chiropractic billing by providing accurate coding for comprehensive care, it does come with certain challenges:

1. Underutilization: Many chiropractors either underuse this code or fail to bill it altogether, missing out on potential reimbursement for extraspinal care.

2. Payer Variability: Some insurance companies may limit or deny payment for extraspinal adjustments, making it tricky to get consistent reimbursement.

3. Documentation Requirements: Proper and thorough documentation is essential to support the use of this code. Incomplete documentation can lead to denials, audits, or reimbursement delays. The lack of familiarity with the 98943 CPT code reimbursement process can lead to delayed payments or outright denials.

4. Coordination with Other CPT Codes: When billing 98943 alongside spinal adjustment codes (98940-98942), chiropractors must ensure accurate code pairing and modifiers to avoid billing errors.

Claim Denials: Denied claims are a common outcome when the 98943 procedure code is used incorrectly. Whether due to a lack of sufficient documentation or misunderstanding payer guidelines, denied claims slow down cash flow and add administrative burdens. For chiropractors, these delays can accumulate and significantly affect the practice’s financial health.

Documentation Needed for Using 98940 CPT code

To maximize the chances of reimbursement and avoid denials, documentation is key. When using 98943 CPT code reimbursement, your documentation should clearly outline:

Patient’s Medical Necessity: Why is an extremity or extraspinal adjustment necessary? Provide detailed information about the patient’s condition, symptoms, or diagnosis that supports the need for extraspinal manipulative therapy.
Treatment Performed: Accurately document the specific treatment provided to the extraspinal area. Note whether it was a shoulder, knee, or other extremity adjustment.
Treatment Plan: Include how the extraspinal adjustment fits into the patient’s overall treatment plan and progress.
Differentiation from Spinal Adjustments: Ensure that the documentation differentiates the extraspinal treatment (98943) from spinal manipulative treatments (98940-98942).

Important Things to Keep in Mind When Using CPT Code 98943

Here are some key factors to consider when using CPT 98943:

• Check Insurance Policies

Before billing 98943, confirm that the patient’s insurance policy covers extraspinal adjustments. Some payers may have restrictions or require prior authorization for these treatments.

For Example: Before billing CPT 98943 for an extraspinal adjustment (like treating a patient’s knee pain), it’s important to check if the patient’s insurance policy covers it. Some insurers may only cover spinal adjustments and require prior authorization for extraspinal treatments. Confirm the policy details, submit a prior authorization request, and receive approval before billing 98943 for the extraspinal treatment.

• Use Proper Modifiers

Use appropriate modifiers if needed. For instance, when billing 98943 alongside spinal adjustments, use the modifier to indicate that both services are distinct but necessary.

For instance, when billing CPT 98943 along with spinal adjustments (CPT 98940-98942), using the correct modifier is essential. I had a patient who needed both spinal and extraspinal care—lumbar adjustment for lower back pain and an elbow adjustment for tennis elbow. To bill for both, you can use modifier 59 with CPT code 98943 to show that the spinal and extraspinal services were distinct and necessary, ensuring proper reimbursement.

• Correct Pairing with Spinal Codes

Ensure CPT 98943 is paired with the correct spinal adjustment codes (98940-98942) if treating both spinal and extraspinal areas during the same visit.

If you’re treating both spinal and extraspinal regions during the same visit, make sure you’re pairing the codes correctly. For example, you treated a patient’s thoracic spine (using CPT 98941) and also performed an extraspinal adjustment on their shoulder. You can pair CPT 98943 with 98941, making sure the codes reflect both the spinal and extraspinal treatments.

• Avoid Overbilling

Don’t overuse CPT 98943. Ensure that the treatment provided genuinely addresses an extraspinal region that requires chiropractic care.

For instance, if you treated a patient with chronic ankle pain, and after several sessions, the condition improved significantly. Instead of continuing to bill CPT 98943 for every visit, only use the code when extraspinal treatment was truly needed, ensuring ethical billing and avoiding potential issues with overbilling.

Mistakes to Avoid When Using 98943 CPT Code

A. Incomplete Documentation

Failure to properly document the need for and the details of an extraspinal adjustment is one of the leading reasons for denials when billing 98943 chiropractic code. Ensure your notes include enough details to justify the use of this code.

B. Improper Code Pairing

Billing 98943 CPT code with incompatible or incorrect spinal adjustment codes (98940-98942) can lead to billing errors and claim rejections. Always verify that codes are correctly paired and modifiers are applied if needed.

C. Assuming All Payers Reimburse for 98943

Not all insurance companies or health plans cover extraspinal manipulations. Always check coverage policies before billing this code.

D. Neglecting Patient Education

Patients may not understand why they’re being charged for extraspinal treatments. Educate your patients about the importance and benefits of treating both spinal and extraspinal issues.

Conclusion

Chiropractic billing efficiency is important for a thriving practice. The 98943 CPT code offers chiropractors a way to accurately bill for extremity manipulations, ensuring they capture the full scope of their services. By understanding the code, optimizing reimbursement strategies, and maintaining proper documentation, chiropractors can avoid costly errors and ensure timely payments.

Mastering the correct usage of 98943 CPT code is an essential step in improving the financial health of your practice. By staying informed and proactive in your billing practices, you can optimize your reimbursement processes, enhance revenue, and deliver exceptional patient care without the administrative headaches of coding errors.

Related Articles:

The Complete Guide to CPT Code 98940 for Maximum Reimbursements

The Ultimate Guide to CPT Code 98942 for Chiropractic Practice

Top 8 Free Resources To Streamline Chiropractic Medical Billing

Know The Top Chiropractic CPT Codes That Can Save Your Billing Time