Most Common Chiropractic CPT Codes and Their Usage

In chiropractic care, accurate coding is essential to ensure correct billing and proper reimbursement for services rendered. CPT (Current Procedural Terminology) codes help describe the various treatments and services provided by chiropractors, allowing for efficient processing of claims by insurance companies. 

Understanding the most commonly used Chiropractic CPT codes can significantly streamline your billing practices and ensure that you are reimbursed correctly and promptly.

What are CPT Codes?

CPT codes are a standardized set of medical codes used to report medical, surgical, and diagnostic procedures. In chiropractic care, these codes describe the specific services provided, helping to ensure that chiropractors receive appropriate payment for their treatments. 

With chiropractic care being a $15 billion industry in the United States alone, the accurate use of chiropractic CPT codes is essential for reducing claim denials and ensuring timely, appropriate reimbursement. Properly coding chiropractic treatments not only ensures compliance but also improves cash flow by ensuring that practices are reimbursed for all services rendered.

Most Common Chiropractic CPT Codes

In chiropractic care billing, using the right CPT codes ensures that services are accurately billed and properly reimbursed. Below are some of the most commonly used chiropractic CPT codes, each describing specific chiropractic services and treatments provided to patients.

CPT Code 98940: Chiropractic Manipulative Treatment (CMT) – 1-2 Regions

CPT Code 98940 is used for Chiropractic Manipulative Treatment (CMT) when the chiropractor adjusts one or two regions of the spine. This code is typically used for less complex cases, where fewer spinal areas require treatment. According to the American Chiropractic Association, approximately 35 million Americans visit chiropractors annually to alleviate back pain and related conditions.

The chiropractor may focus on specific spinal joints or segments, providing relief for localized pain, stiffness, or dysfunction. By using this code, chiropractors ensure that their services are accurately billed for a targeted treatment approach.

CPT Code 98941: Chiropractic Manipulative Treatment (CMT) – 3-4 Regions

CPT Code 98941 applies when a chiropractor performs spinal manipulation or adjustment on three to four regions of the spine. This code is used for more extensive cases where multiple spinal areas need treatment. 

It may be applied to patients experiencing widespread pain or dysfunction that involves several regions of the spine, such as the neck, lower back, or mid-back. By using this code, chiropractors reflect the increased complexity and broader scope of the treatment provided.

CPT Code 98942 – Chiropractic Manipulative Treatment (CMT) – 5 Regions

CPT Code 98942 is used when a chiropractor performs spinal manipulation on five regions of the spine. This code is typically used in more complex cases where comprehensive treatment is required across the entire spine. 

The chiropractor adjusts multiple spinal segments to alleviate pain, improve function, and restore mobility. This code is useful for patients with widespread musculoskeletal issues that require a full-body treatment approach.

CPT Code 97012 – Mechanical Traction

CPT Code 97012 is used when mechanical traction is applied to the spine to relieve pain, reduce pressure on the discs, and improve mobility. This technique involves the use of mechanical equipment that gently pulls or stretches the spine, which can help patients with conditions such as herniated discs, degenerative disc disease, or muscle spasms. Mechanical traction is often used in combination with other chiropractic treatments, and its goal is to reduce discomfort and improve spinal alignment.

A meta-analysis published in the Physical Therapy Journal evaluated the effects of different types of traction on pain and disability. The study found that traction, including mechanical traction, can be an effective conservative treatment for lumbar radiculopathy, a condition often associated with herniated discs.

CPT Code 97140 – Manual Therapy Techniques

CPT Code 97140 is used for manual therapy techniques, including massage, myofascial release, and joint mobilization. These techniques are designed to treat muscle tightness, improve flexibility, and alleviate pain in soft tissues and joints. 

Chiropractors may use this code when manually manipulating the muscles and joints to reduce tension, increase blood flow, and restore function. Manual therapy is commonly used for conditions like muscle strains, chronic pain, and limited range of motion.

CPT Code 99213 –  Office Visit

CPT Code 99213 is used for an office visit with an established patient, where the chiropractor performs a detailed evaluation of the patient’s condition. This code is typically used for routine follow-up visits to assess the patient’s progress, review any new symptoms, and adjust the treatment plan as necessary. 

During these visits, the chiropractor may provide additional care instructions, discuss lifestyle modifications, and recommend further therapy if needed.

CPT Code 99396 – Preventive Medicine

CPT Code 99396 is used for preventive care visits with an established patient. This code applies when the chiropractor performs a comprehensive examination and evaluation aimed at promoting overall health and preventing future musculoskeletal issues. 

During these visits, the chiropractor may provide recommendations on posture, ergonomics, and exercise routines to maintain spinal health and prevent injuries.

Billing Best Practices for Chiropractors

To ensure accurate reimbursement and reduce claim denials, chiropractors should follow these billing best practices:

• Document Thoroughly: Ensure detailed records of services provided to support claims and avoid confusion.
• Use Correct CPT Codes: Match the right code to each service to improve claim acceptance.
• Verify Insurance Coverage: Confirm patient benefits before treatment to avoid billing issues.
• Submit Claims Promptly: Submit claims within the allowed timeframe to avoid delays or denials.
• Follow Up on Denials: Address denied claims quickly to ensure proper payment.
• Educate Patients: Inform patients about their coverage, co-pays, and deductibles to prevent surprises.

By implementing these practices, chiropractors can streamline their billing process and improve reimbursement accuracy.

Conclusion

Accurate and efficient coding of chiropractic services is crucial for ensuring timely reimbursement and minimizing claim denials. By understanding the most common chiropractic CPT codes and their appropriate usage, chiropractors can improve their billing processes and focus more on providing high-quality care to their patients. 

For those looking to streamline their billing practices and maximize reimbursements, our chiropractic billing services will help your practice boost cash flow and minimize denials.