Chiropractic CPT Codes – What Chiropractors Need To Know – ChiroFusion (2023)

Chiropractic CPT Codes are published and maintained by the American Medical Association and are one of the most important code sets for chiropractors to become familiar with.

Each CPT codes contain five alpha-numeric characters used to describe all the evaluations, diagnostic tests and medical procedures performed by a chiropractor on a patient. As you might imagine, this code set is extremely large and contains tens of thousands of medical procedures.

CPT Codes & Chiropractic

While there are three primary categories of CPT codes, most chiropractors use only Category 1 codes. CPT codes in this category describe procedures performed by healthcare providers in inpatient and outpatient offices. Some examples common CPT codes used by chiropractors include:

  • CPT Code 99203 – Initial Exam
  • CPT Code 98940 - Chiropractic manipulative treatment (CMT); spinal, 1-2 regions
  • CPT Code 97110 – Therapeutic Exercise

Chiropratic Modifier Codes

There are also two charactermodifiersthat can be attached to certain codes to tell insurance companies that there is something different about the services related to the CPT code being billed. Codes that require a modifier, but are billed without one, will be rejected by the insurance company.

While there are several modifiers, the two most commonly used in modifiers by chiropractors are modifier 25 and modifier 59. The key to using modifiers to ensure maximum reimbursement is to understand each payer’s specific recommendations on the matter.

Chiropratic CPT Codes List

CPT codes are an integral part of the chiropractic billing process. Chiropractic billing codes tell the insurance company what procedures the chiropractor is performing and would like to be reimbursed for. Insurance companies use CPT codes to track health data and measure the prevalence and value of certain medical procedures.

Unlike medical providers, chiropractors use a limited set of CPT codes. There are only four codes for chiropractic manipulative treatment – all of which are based on the spinal regions treated:

  • 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
(Video) Confusing Codes for Chiropractors 🤷‍♀️ 97110 versus 97112 versus 97530

When billing for chiropractic manipulation or adjustments, the accompanying documentation must reference the proper number of spinal regions per code. For example, if billing CPT code 98941, your documentation should reference 3-4 spinal regions with dysfunction or misalignment. Documenting dysfunction in only 1-2 spinal regions would result in a rejected claim from the insurance carrier.

Here is a list of the most commonly billed chiropractic CPT codes

  • 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 CPT Code Cheat Sheet

By making your own list of commonly-used CPT codes, you’ll begin to discover patterns in the types of conditions you see or in the therapeutic needs your patients have. From there, you can learn how to quickly use these codes, while also providing the proper documentation to get reimbursed for your services.

While creating your coding cheat sheet, you may want to also create a list of codes that cause the most trouble for your office. By looking for problem codes, you may identify areas where additional coding training is needed or additional documentation is necessary.

Chiropractic Billing Codes - Tips & Advice

Chiropractic billing can be complicated. Successful reimbursement depends on more than just the proper CPT codes. Insurance reimbursement is contingent upon the patient’s coverage, proper documentation, and finally, using the proper billing codes.

These tipsthat will help improve your financial process and insurance reimbursements.

(Video) Chiropractic EHR Software by ChiroFusion
  • Understand your patients insurance coverage. Two patients can have the coverage from the same company, but their insurance contract can be different. Conversely, one insurance carrier might reimburse for a specific CPT while another one will deny it. Checking eligibility prior to every new patient appointment is therefore the essential first step in the claim revenue cycle.
  • Always complete pre-authorizations before starting treatment (if applicable). Even if a patient has the chiropractic benefits on their plan, your claims may be denied if there are pre-authorization requirements in place.
  • Analyze denied claims. One of the biggest issues that negatively affect revenue is denied claims. In fact, according to the Government Accountability Office, up to 25% of insurance claims are denied. By analyzing your denials, you can identify patterns that can be corrected.
  • Understand Medicare's billing and documentation requirements. Chiropractors have one of the highest error rates when billing Medicare. This rate includes rejected and denied claims. The only chiropractic CPT codes covered by Medicare are 98941, 98942 and 98943. All other CPT codes billed to Medicare will be denied. Also, when submitting a claim to Medicare for manipulation, you must include the Acute Treatment (AT) modifier if you expect to get paid.​
  • Properly document your patient encounters. To minimize the odds of triggering an audit and possibly paying penalties and fines, be sure to properly document your encounters. Your SOAP notes should indicate the need for treatment, and include treatment goals, objective measures for patient progress, the patient’s progression and the treatment plan. The latter should include duration and frequency. When billing Medicare, be sure all documentation is complete and according to established guidelines.​

How ChiroFusion Can Help With Chiropractic CPT Codes

(Video) What Story Do RecordsTell? Learn about Compliant Chiropractic Protocols

ChiroFusion’schiropractic billing software and revenue cycle management services make it easy to bill for chiropratic CPT codes, and to properly document patient encounters. Claims can be submitted directly from within our chiropractic billing software to the clearinghouse in one click.

Chiropractic CPT Codes FAQ

Q. What are chiropractic billing codes?

A. Chiropractic billing codes, known as CPT codes, are numbers assigned to treatments or services that a chiropractor may provide to a patient including medical and diagnostic services.

Q. What are chiropractic modifiers?

A. Chiropractic modifiers can be attached to certain CPT codes to tell insurance companies that there is something different about the services related to the CPT code being billed. While there are several modifiers, the two most commonly used in modifiers by chiropractors are modifier 25 and modifier 59.

(Video) How to Use ChiroFusion - Beginners Guide 2022

Q. What CPT codes do chiropractors use?

A. While there are three primary categories of CPT codes, most chiropractors use only Category 1 codes. The most common CPT codes used by chiropractors are CPT Code 98940, CPT Code 98941, CPT Code 98942, and CPT Code 98943.

Q. What are the most commonly billed chiropractic CPT codes?

A. The most commonly billed chiropractic CPT codes are CPT Code 98940 Chiropractic manipulative treatment (CMT); Spinal, 1-2 regions, CPT Code 98941 Chiropractic manipulative treatment (CMT); Spinal, 3-4 regions, and CPT Code 98942 Chiropractic manipulative treatment (CMT); Spinal, 5 regions.

FAQs

What is the CPT code 98940? ›

CPT® 98940, Under Chiropractic Manipulative Treatment Procedures. The Current Procedural Terminology (CPT®) code 98940 as maintained by American Medical Association, is a medical procedural code under the range - Chiropractic Manipulative Treatment Procedures.

What are three contraindications to chiropractic? ›

Don't seek chiropractic adjustment if you have:
  • Severe osteoporosis.
  • Numbness, tingling, or loss of strength in an arm or leg.
  • Cancer in your spine.
  • An increased risk of stroke.
  • A known bone abnormality in the upper neck.

What does CPT code 98943 mean? ›

Chiropractic Manipulation Treatment

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).

Do chiropractors use CPT codes? ›

While there are three primary categories of CPT codes, most chiropractors use only Category 1 codes. The most common CPT codes used by chiropractors are CPT Code 98940, CPT Code 98941, CPT Code 98942, and CPT Code 98943.

What are the 5 regions for chiropractic manipulation? ›

For purposes of CMT, the five spinal regions referred to are: cervical region, (includes atlanto-occipital joint); thoracic region (includes costovertebral and costotransverse joints); lumbar region; sacral region; and pelvic (sacro-iliac joint) region.

Can a chiropractor bill 97140? ›

By Mark A.

American Medical Association (AMA) coding guidelines dictate that it is only appropriate to bill for Chiropractic Manipulative Treatment (CMT) and manual therapy (CPT code 97140) for the same patient on the same visit under certain circumstances.

What does CPT code 97140 mean? ›

CPT® code 97140: Manual therapy techniques, 1 or more regions, each 15 minutes (Mobilization/manipulation, manual lymphatic drainage, manual traction)

What is CPT G0283? ›

HCPCS code G0283 for Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care as maintained by CMS falls under Miscellaneous Diagnostic and Therapeutic Services .

When should you stop chiropractic treatment? ›

In general, it is advised to discontinue chiropractic care if any of the following is true:
  1. Increased pain. It is not uncommon to note mild discomfort after the initial manipulation treatment for the first 24 to 48 hours (similar to starting a new exercise). ...
  2. No improvement within 2 to 4 weeks. ...
  3. Symptoms have gone away.

Can a chiropractor help with nerve damage? ›

Once the underlying condition is diagnosed, a chiropractor can design a treatment plan to eliminate irritation, correct misalignments causing pressure, and restore proper nerve function.

What are the disadvantages of chiropractic therapy? ›

Disadvantages:
  • Spinal and joint manipulation has a chance to go wrong and may cause unwanted fractures or injuries. So it is important that you only have an appointment with an experienced chiropractor.
  • The cost of treatment can be quite high.
  • Some insurance companies do not have coverage for chiropractic care.
28 Feb 2011

Can a chiropractor bill 97124? ›

First, the codes 97112, 97124 and 97140 require the modifier 59 (distinct procedural service) when performed at the same encounter as a chiropractic adjustment. The 59 modifier instructs the insurance carrier's software not to “bundle” the two procedures together, resulting in a denial of payment.

What does CPT code 97124 mean? ›

Describes the work inherent in massage, which is a separate and distinct service from codes 98940-98943. CPT code 97124 describes work including effleurage, petrissage, and/or tapotement (stroking, compression, percussion) for every 15 minutes.

What does CPT code 98941 mean? ›

98941. Chiropractic manipulative. treatment (CMT) involving. three to four spinal regions.

Can a chiropractor bill CPT code 97530? ›

97530 CPT code can be billed for therapeutic activity. This CPT code for therapeutic activity includes many rehabilitative procedures that use whole-body movement to gradually improve functional performance, such as bending, lifting, carrying, reaching, catching, transfers, and overhead activities.

What modifiers are needed for chiropractic billing? ›

Modifiers in Chiropractic Medical Billing:
  • Modifier 25. Modifier 25 is utilized to show that this is an important, independently recognizable evaluation and management (E/M) service by the same physician on the same day. ...
  • GA Modifier. ...
  • GY Modifier. ...
  • Modifier 59. ...
  • X-set Modifiers. ...
  • The Active Treatment (AT) Modifier.
25 May 2020

What does CPT code 97012 mean? ›

From a CPT® coding perspective, 97012 is a physical medicine mechanical traction modality that does not require attendance. Various other modalities might also assist in accomplishing and/or complementing some of the same objectives as the CMT codes or 97012.

What is an Extraspinal adjustment? ›

Extraspinal manipulation, also known as extraspinal manipulative therapy (EMT), is used to treat joint dysfunction outside of the vertebral column.

What can be billed under 97110? ›

CPT® code 97110: Therapy procedure using exercise to develop strength, endurance, range of motion and flexibility, each 15 minutes.

What is a Sublux? ›

"Subluxation" is a term used by some chiropractors to describe a spinal vertebra that is out of position in comparison to the other vertebrae, possibly resulting in functional loss and determining where the chiropractor should manipulate the spine.

Can 97110 and 97140 be billed together? ›

Can CPT Code 97110 And 97140 Be Billed Together? Yes, they can be billed together. CPT 97110 and CPT 97140 can be performed on the same day for the same patient; instead, using these codes together on the same day is very common.

Can 97162 and 97140 be billed together? ›

Yes. It's possible to bypass the edit by using the 59 modifier/X modifier when billing 97140 with the physical therapy evaluation codes (97161, 97162, or 97163). If you don't use the modifier for this combination of codes, CMS will deny the manual therapy code.

Does CPT 97140 need a modifier? ›

The 97140 CPT code is appended with the modifier -59 or the appropriate -X modifier.

What does CPT code 97112 mean? ›

The definition of 97112: Therapeutic procedure, one or more areas, each 15 minutes – Neuromuscular Reeducation of movement, balance, coordination, kinesthetic sense, posture and/or proprioception for sitting and/or standing activities.

What CPT code is 97161? ›

97161, “Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact the plan of care.

What is procedure code 97750? ›

The description of CPT code 97750 is “Physical performance test or measurement (eg, musculoskeletal, functional capacity), with written report, each 15 minutes”.

What is the difference between G0283 and 97032? ›

Stimulation delivered by vaginal or anal probes connected to an external pulse generator may be billed as 97032. Stimulation delivered via electrodes should be billed as G0283.

What does CPT code 97033 mean? ›

The Current Procedural Terminology (CPT®) code 97033 as maintained by American Medical Association, is a medical procedural code under the range - Constant Attendance Physical Medicine and Rehabilitation Modalities.

What is the difference between G0283 and 97014? ›

G0238 is a HCPCS code listing electrical stimulation service and 97014 is a procedure code that is for electrical stimulation. So both of these codes are state the same text but are from different National Coding structures.

Why do chiropractors require so many visits? ›

Common Chiropractic Adjustment Frequencies

To achieve maximum benefits, most injury and pain types will need somewhere between four and twelve sessions. Ongoing maintenance is used to prevent pain from coming back and to prevent additional injuries from forming due to a misalignment of the spine.

Can you get adjusted too much? ›

Over-manipulation syndrome can begin after high velocity adjustments from a chiropractor or through self-manipulation. While chiropractors provide wonderful care in many cases, there is a risk of damaging the ligament structures and causing joint instability with continued high-velocity adjustments.

How do you know if a chiropractor is good? ›

What to Look for When Choosing a Chiropractor
  • Try to get a referral. ...
  • Check if any of the recommended chiropractors are covered by your insurance plan. ...
  • Do a quality check for credentials by accessing your state licensing board's website to confirm qualifications and any possible disciplinary action.
28 Sept 2017

Can a chiropractor fix a pinched sciatic nerve? ›

A sciatica chiropractor can provide lasting relief. Sciatica is—quite literally—a pain in the butt. But rather than visiting your primary care physician (or, worse yet, suffering through it), seeking chiropractic treatment can not only alleviate your symptoms but also treat the underlying cause of your sciatica.

Can a chiropractor release a trapped nerve? ›

A chiropractor can use adjustments to release a pinched nerve, addressing the root cause of the issue. This can help someone recover without requiring invasive procedures or medications that could otherwise lead to side effects.

Can chiropractors fix sciatica nerve pain? ›

The bottom line. A chiropractor might be able to help relieve sciatica pain. Using spinal manipulation techniques and other natural practices, chiropractors can help relieve the pressure on your sciatic nerve.

How much does a chiropractor make? ›

How Much Does a Chiropractor Make? Chiropractors made a median salary of $70,720 in 2020. The best-paid 25 percent made $98,050 that year, while the lowest-paid 25 percent made $53,070.

Why is it important to drink water after a chiropractic adjustment? ›

If you don't drink enough water after a chiropractic adjustment, your ligaments can lose elasticity and strength due to dehydration. This can leave you sore or worse. So, it's imperative to drink water after an adjustment and to, of course, always stay hydrated.

Do chiropractors realign the spine? ›

A chiropractic adjustment is a therapeutic treatment by a licensed chiropractor. Your chiropractor will use pressure to manipulate joints in your body to realign your spine and reduce pain and discomfort.

Can a chiropractor bill 97140? ›

By Mark A.

American Medical Association (AMA) coding guidelines dictate that it is only appropriate to bill for Chiropractic Manipulative Treatment (CMT) and manual therapy (CPT code 97140) for the same patient on the same visit under certain circumstances.

Can a chiropractor bill 97110? ›

CPT Code 97110 For Chiropractic Exercises

The description of CPT 97110 states “therapeutic exercise,” which can include any kind of exercise performed by a physical therapist, occupational therapist, or chiropractic.

Can a chiropractor bill CPT code 97530? ›

97530 CPT code can be billed for therapeutic activity. This CPT code for therapeutic activity includes many rehabilitative procedures that use whole-body movement to gradually improve functional performance, such as bending, lifting, carrying, reaching, catching, transfers, and overhead activities.

What chiropractic codes does Medicare cover? ›

Doctors of chiropractic are limited to billing three Current Procedural Terminology (CPT) codes under Medicare: 98940 (chiropractic manipulative treatment; spinal, one to two regions), 98941 (three to four regions), and 98942 (five regions).

Can a chiropractor bill 97112? ›

Now chiropractors must be paid for neuromuscular reeducation (97112), massage (97124), and manual therapy (97140) when “performed on separate anatomic sites or at separate patient encounters on the same date of service as a chiropractic manipulative treatment (98940—98942).” This was perhaps the biggest reimbursement ...

What is CPT G0283? ›

HCPCS code G0283 for Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care as maintained by CMS falls under Miscellaneous Diagnostic and Therapeutic Services .

What can be billed under 97110? ›

CPT® code 97110: Therapy procedure using exercise to develop strength, endurance, range of motion and flexibility, each 15 minutes.

What is the difference between 97140 and 97530? ›

Code 97530 is mutually exclusive with code 97140 but a modifier is allowed in order to differentiate between the services provided. Code 97140 is mutually exclusive with code 97530 and cannot be billed using any modifier.

What is the difference between 97110 and 97530? ›

If only one outcome is intended by the exercise, CPT code 97110 should be used. Where more than one outcome is expected using balance boards, fitness balls, stretch bands, etc. where increased motion, flexibility, strength and/or improved proprioception is intended, CPT code 97530 should be used.

Can you bill 3 units of 97110? ›

Do not bill 3 units for either one of the codes. 33 minutes of therapeutic exercise, 97110. 7 minutes of manual therapy, 97140.

What modifiers are needed for chiropractic billing? ›

Modifiers in Chiropractic Medical Billing:
  • Modifier 25. Modifier 25 is utilized to show that this is an important, independently recognizable evaluation and management (E/M) service by the same physician on the same day. ...
  • GA Modifier. ...
  • GY Modifier. ...
  • Modifier 59. ...
  • X-set Modifiers. ...
  • The Active Treatment (AT) Modifier.
25 May 2020

Can 97110 and 97530 be billed together? ›

You will not be able to use a 59 modifier to charge 97530 with an initial evaluation. Note that you can continue to bill other timed codes, such as 97110, 97112 and 97140 with an initial evaluation. However, you will now be required to use a 59 modifier if you bill 97140 (manual therapy) with an initial evaluation.

What does CPT code 97530 pay? ›

What is CPT Code 97530 Therapeutic Activities? CPT code 97530 is therapeutic activities, using dynamic activities one on one patient contact by the provider to improve functional performance (real-life movements), each 15 minutes.

What is the Medicare deductible for chiropractic 2022? ›

The Medicare deductible for 2022 is $233 and represents a $30 increase from 2021. For chiropractic providers, it is important to understand that the deductible applies to Medicare-covered services, which for chiropractic is spinal manipulation 98940, 98941 and 98942 only.

How many chiropractic adjustments Does Medicare pay for? ›

As part of your Medicare coverage you are entitled to up to five bulk billed chiropractic visits a year fully paid for by Medicare. This is organised by your GP through a Chronic Disease Management plan (CDM) or Team Care Arrangement (TCA). This coverage can save you over $250 in health care costs.

Can a chiropractor bill Medicare? ›

Medicare doesn't cover other services or tests a chiropractor orders, including X-rays, massage therapy, and acupuncture (unless the acupuncture is for the treatment of chronic low back pain).

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