When to use CPT code 98940 instead of 98941?
• Codes for spinal manipulations (98940 – 98942) are specific to the number of regions treated. If only two regions are treated, 98940 should be used instead of 98941–52 Claims submitted for CPT code 98940, 98941, or 98942 with the demonstration code “demo 45” shall be rejected.
When to Bill chiropractic manipulative treatment (98940-98942)?
These E/M services may be billed in addition to the chiropractic manipulative treatment (98940-98942) ONLY when the patient has not received any professional (face-to-face) services from the chiropractor, or another chiropractor of the same group practice, within the past three years.
Is 97140 CPT code covered by payers?
Since so many providers were found to have “done it wrong,” a knee-jerk reaction ensued when some payers never covered both CMT and 97140 on the same visit. Only upon appeal, with clear documentation of the separately identifiable regions, would the 97140 CPT code service be paid.
How often are CPT vignettes updated?
Where appropriate, there are also Pre- and Post-service descriptions. Vignettes are reviewed annually and updated when necessary. 300-400 new vignettes are added each year as codes added, revised and reviewed. Available for over 5000 of the most common CPT codes.
What does CPT code 98941 include?
98941- Chiropractic manipulative treatment (CMT); spinal, three or four regions.
Does 98941 need a modifier?
When providing maintenance therapy, no modifier is required when billing procedure codes 98940, 98941, or 98942. The AT modifier must not be placed on the claim when maintenance therapy has been provided. Claims without the AT modifier will be considered as maintenance therapy and denied.
Is 98941 covered by Medicare?
Diagnosis Code Description Medicare Covered Chiropractic Services If the CPT code is 98940, 98941, or 98942 and is billed with one of the following primary diagnosis codes and with modifier AT, then the chiropractic service is covered.
How many spinal CMT codes are there?
four codesThere 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.
How do I bill a chiropractic claim?
Complete Guide to Chiropractic Billing in 2020Evaluate accounts receivable.Reduce excessive accounts receivable.Improve code accuracy.Analyze denied claims.Improve verification stage.Send clean claims.Hire help.Look into chiropractic practice management software.
What chiropractic CPT codes are covered by Medicare?
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).
How many chiropractic visits can you have with Medicare?
The program will cover up to 12 sessions over 90 days, with a potential eight additional sessions if symptoms are improving.
What is the Medicare allowable rate for chiropractic services?
The result is a Medicare allowable amount cut of 19.54% for chiropractic adjustments.
How much does a chiropractor cost?
Each visit with a chiropractor can cost between $30 and $200 for the average person. Generally, intensive treatments are more expensive than something like an adjustment. In fact, adjustments are offered for between $50 and $75 each by most chiropractic offices.
What are the 5 Extraspinal regions?
The five extraspinal regions referred to are: head (including temporomandibular joint, excluding altanto-occipital) region; lower extremities; upper extremities; rib cage (excluding costotransverse and costovertebral joints) and abdomen.
What is an Extraspinal manipulation?
Manipulation or chiropractic (therapeutic) manipulation, commonly referred to as spinal and extraspinal adjustment, manual adjustment, vertebral adjustment, or spinal manipulative therapy (SMT), is the treatment of the articulations of the spine and musculoskeletal structures, including the extremities, for the purpose ...
What is a CMT code?
The chiropractic manipulation treatment (CMT) codes include a pre-manipulation patient assessment, the adjustment, and evaluation of the effect of treatment. The CMT codes 98940- 98942 are used to indicate the number of spinal areas manipulated.
What is the CMT code for the spinal region?
For purposes of CMT, the five spinal regions referred to are: • Pelvic (sacroiliac joint) region. Modifier -51 (Multiple Procedures) is not required to be appended to the extraspinal CMT procedural code (98943), when billed on the same date of service as a spinal CMT code (98940-98942).
Is it appropriate to bill an E&M with each CMT?
CMT codes include a pre-manipulation patient assessment component for each visit, which must be supported by appropriate documentation. Therefore, it is not appropriate to bill an E&M service with each CMT service. If billed inappropriately, the E&M service will be denied as provider liable.
Does Moda Health have multiple procedure fee reductions?
Moda Health does not apply multiple procedure fee reductions to Osteopathic Manipulative Treatment (OMT) procedures or Chiropractic Manipulative Treatment (CMT) procedures. Despite the AMA modifier definition and ChiroCode guidelines indicating to use modifier 51 with chiropractic services, Moda Health follows CMS guidelines as described above. OMT and CMT procedure codes have a multiple procedure indicator of “0” and modifier 51 should not be used in combination with these procedure codes. Moda Health will deny 98925 – 98929 and 98940 – 98943 for invalid modifier to procedure combination when billed with modifier 51
Does insurance reimburse for CPT?
Contrariwise, one insurance carrier might reimburse for a specific CPT while the second one will deny it. Verifying eligibility prior to each and every new patient appointment is therefore the essential first step in the claim revenue cycle. Also, you need to verify existing patient eligibility after a certain period.
Do you have to pre-authorize for chiropractic?
You have to complete pre-authorizations before starting treatment (if applicable). If the patient has the chiropractic benefits on their plan, your claims may be denied if there are pre-authorization requirements in place. Analyze denied claims.
The pesky early years of the 97140 code
One of the biggest challenges faced by doctors of chiropractic (DCs) was that the old code 97150-Myofascial Release, which many providers used for trigger-point therapy, was billed along with the CMT code for any muscle work performed in conjunction with the adjustment.
The pesky 97140 CPT Code: 2021
Some payers, such as Optum, have finally taken the guesswork out of when and how to append the -59 modifier when performing CMT along with procedure code 97140 – manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction) on one or more regions (15 minutes each).
How would you answer these questions?
Considering the increasing scrutiny and number of audits, it’s time for a self-check to make sure you have what’s necessary to properly bill both CMT and 97140 on the same visit:
Timed codes
Several CPT codes used for therapy modalities, procedures, and tests and measurements specify that direct (one-on-one) time spent with the patient is 15 minutes. Report procedure codes for services delivered on any single calendar day using CPT codes and the appropriate number of 15 minute units of service.
Examples
The following examples illustrate how to count the appropriate number of units for the total therapy minutes provided.
Untimed codes
The units for untimed codes are reported based on the number of times the procedure is performed, as described in the HCPCS code definition (often once per day). When reporting service units for codes where the procedure is not defined by a specific timeframe (untimed codes), a 1 is entered in the unit's field.
Reference
CMS, Internet Only Manual, Publication 100-04, Claims Processing Manual, Chapter 5, Section 20.2
