CPT Code 98940: Chiropractic Manipulative Treatment; Spinal, 1-2 Regions

This quick reference guide to CPT Code 98940 answers frequently asked questions from our community of chiropractors. You can see the complete library of CPT codes here, courtesy of ChiroTouch, the cloud-based EHR designed specifically for chiropractors. 

About CPT Code 98940: Chiropractic Manipulative Treatment (CMT)

Chiropractic manipulative treatment (CMT) is a common procedure performed by chiropractors to address musculoskeletal conditions and promote the overall health and well-being of patients. CPT code 98940 is used to report a CMT service that involves spinal manipulation.

Here’s what chiropractors need to know about using CPT code 98940.

Category or Type of Service

CPT code 98940 is a chiropractic manipulative treatment (CMT) code. It is a standalone code that represents spinal manipulation services provided by a chiropractor.

Billing Interval

This code is typically billed as a single unit. Each unit represents one session of chiropractic manipulative treatment.

When Should Chiropractors Use This Code?

Chiropractors should use CPT code 98940 to report chiropractic manipulative treatment services involving spinal manipulation. This code can be used to address various musculoskeletal conditions, such as:

• Back pain
• Neck pain
• Headache
• Sciatica
• Carpal tunnel syndrome

Chiropractors may perform CMT as a standalone service or as part of a comprehensive treatment plan. It is important to document the specific areas of the spine that were manipulated during the treatment session.

When Should Chiropractors Not Use This Code?

Chiropractors should not use CPT code 98940:

• For services that do not involve spinal manipulation. For example, if the treatment session solely focuses on therapies like ultrasound or electrical stimulation without any spinal manipulation, a different code should be used to report those services.
• To report CMT that is performed on more than two regions of the spine. In these cases, the code for CMT that is performed on three or more regions of the spine (CPT code 98941) should be used.

Which Modifiers Can Be Used With CPT Code 98940?

The following modifier codes can be used with CPT code 98940:

• Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified healthcare professional on the same day of the procedure or other service.
• Modifier 59: Distinct procedural service, indicating that the CMT service is separate and distinct from other procedures or services performed during the same encounter.

It is essential to review and comply with payer-specific guidelines when using modifiers to ensure accurate and compliant billing.

What Are the Billing Guidelines and Documentation Requirements Specific to This Code?

The following billing guidelines and documentation requirements apply to code 98940:

• Medical necessity: The chiropractic manipulative treatment must be medically necessary to address a specific condition or symptom. The documentation should clearly describe the patient’s diagnosis, the rationale for the treatment, and the expected therapeutic outcome.
• Date and duration: Each treatment session should be clearly documented with the date of service and the duration of the manipulative treatment.
• Specific spinal areas: Document the specific spinal areas targeted during the treatment session. This includes specifying the region (e.g., cervical, thoracic, lumbar) and any subregions or levels addressed.
• Techniques: Document the techniques used for spinal manipulation, such as diversified, Thompson, or activator methods. Include any additional therapies or modalities provided during the session.
• Patient response: Note the patient’s response to the treatment, including any changes in symptoms, pain levels, or functional improvements.

The documentation must be clear and legible, and it must be signed and dated by the chiropractor who performed the chiropractic manipulative treatment.

What are Examples of ICD-10-CM Codes Often Used With This Code?

The following ICD-10-CM codes are often used with CPT code 98940:

• M54.5 – Low back pain
• M54.2 – Cervicalgia
• M47.812 – Spondylosis without myelopathy or radiculopathy, thoracic region
• M25.511 – Pain in right shoulder
• M51.26 – Other intervertebral disc displacement, lumbar region
• G43.0 – Migraine headache
• L52.1 – Sciatica
• M53.1– Carpal tunnel syndrome

These are just a few examples, and it is important to select the most accurate and specific diagnosis code based on the patient’s condition and the clinical documentation.

What Are Common Mistakes Made Specific to CPT code 98940?

Some common mistakes made with this code include:

• Lack of medical necessity documentation: Failing to clearly document the medical necessity of the chiropractic manipulative treatment, including the patient’s diagnosis, symptoms, and expected therapeutic outcomes.
• Inaccurate coding: Using code 98940 when the service provided does not involve spinal manipulation or using incorrect diagnosis codes that do not support the medical necessity of the treatment.
• Insufficient documentation: Failing to document the specific spinal areas targeted, techniques used, and patient response to the treatment session.

To ensure accurate billing and minimize claim denials, it is crucial to provide thorough and detailed documentation that supports the medical necessity of the service rendered.

What Are Potential Audit Triggers Specific to This CPT Code?

Some potential audit triggers specific to CPT code 98940 include:

• Excessive use of modifier 25: Inappropriately appending modifier 25 to the CMT service when there is insufficient documentation to support a separately identifiable evaluation and management service on the same day.
• Inconsistent documentation: Discrepancies between the diagnosis codes reported, the documented treatment provided, and the medical necessity of the service.

What Can I Do to Improve the Accuracy and Efficiency of My Practice’s Billing and Coding Processes?

There are several steps that chiropractors can take to improve the accuracy and efficiency of their practice’s billing and coding processes:

• Keep current: Stay informed about the latest coding guidelines, changes, and updates related to chiropractic services. Regularly review resources provided by reputable organizations, such as ChiroTouch and professional chiropractic associations.
• Educate staff: Ensure that your staff, including billing and coding personnel, are well trained and up to date on coding requirements and documentation guidelines. Regularly provide training sessions and resources to improve their knowledge and skills.
• Perform internal audits: Conduct regular internal audits to review coding and documentation practices within your staff. Identify any patterns of errors or inconsistencies and take corrective actions to address them.
• Using cloud-based EHR and practice management software: Use chiropractic practice management software, such as ChiroTouch, to streamline your billing and coding processes. Modern chiropractic practice management software often includes features like built-in code libraries, automated claim submission, and compliance checks to reduce errors and enhance efficiency.

How ChiroTouch Simplifies Billing to Increase Profits

In the fast-paced world of chiropractic practice, efficiency and profitability are two sides of the same coin. ChiroTouch, a fully integrated chiropractic practice management software, is designed to help you flip this coin in your favor.

ChiroTouch is not just a tool, but a comprehensive solution that streamlines your workflow, allowing you to work less and earn more. It achieves this by integrating faster charting, online scheduling, payment processing, and automated claims management into a single, user-friendly platform.

Our free guide reveals how EHR inefficiencies could be causing your practice to lose money and how streamlining billing and insurance can significantly boost your revenue. With ChiroTouch, you can eliminate these inefficiencies and enhance your cash flow.

ChiroTouch is a strategic partner that can help you enhance your practice’s revenue, cash flow, and scalability. Leverage its integrated EHR and practice management capabilities to transform your chiropractic practice into a more profitable and efficient business.

To learn more about how ChiroTouch can help your practice improve accuracy, reduce errors and claim rejections, and get paid faster, download our free ebook below or schedule a demo today.