CPT Code 98940: Chiropractic Manipulative Treatment, 1–2 Regions

What is CPT code 98940?

CPT code 98940 represents chiropractic manipulative treatment (CMT) of 1-2 spinal regions. This primary code is used when a provider applies manipulation to address acute or chronic subluxation in either one or two spinal regions during a single patient appointment. Chiropractic manipulative treatment involves manual manipulation techniques designed to influence joint and neurophysiological function by restoring structural integrity and improving physiological function.

This therapeutic service specifically treats areas where joint surfaces remain intact but exhibit abnormal motion segment mobility, affecting movement integrity. During treatment, the healthcare provider delivers a controlled force to a joint, moving it beyond its passive range while the joint surfaces remain intact. This technique aims to restore proper alignment and function to the affected areas.

For coding purposes, the spinal regions are defined as:

• Cervical region (includes atlanto-occipital joint)
• Thoracic region (includes costovertebral and costotransverse joints)
• Lumbar region
• Sacral region
• Pelvic region

When documenting and billing with CPT code 98940, it's essential to specify which of these regions were treated. The number of treated regions determines which CMT code is appropriate.

CPT code 98940 documentation requirements

Proper documentation is crucial for accurate medical coding and to ensure maximum reimbursement for chiropractic services or acute treatment rendered. For each patient encounter where CMT is performed, healthcare providers must include comprehensive documentation that justifies the medical necessity of the services provided.

Pre-manipulation assessment

Before performing chiropractic manipulative treatment, a thorough pre-manipulation assessment must be documented, including:

• Physical examination documentation that identifies the specific subluxation(s)
• Detailed description of the current physical status
• Assessment of how the subluxation affects the patient's function
• Rationale for why CMT is considered medically reasonable and necessary

Treatment documentation

For each treatment session using CPT code 98940, documentation must identify CMT services provided, including:

• Specific regions treated (must be 1-2 regions for 98940)
• The presence of subluxation in each treated region
• The therapeutic procedure performed
• Patient progress in response to treatment
• Updates to the treatment plan based on patient progress

Documentation should reflect the clinical rationale for each visit, demonstrating that the care provided was not maintenance therapy, which is generally not covered in insurance claims.

CPT code 98940 billing guidelines

Understanding the proper billing guidelines for CPT code 98940 is essential for revenue cycle management and minimizing denied claims. When submitting claims for chiropractic services, it's important to adhere to general coding guidelines and specific requirements for chiropractic claims and benefits.

Insurance coverage considerations

Most insurance plans, including Medicare, recognize chiropractic manipulative treatment for specifically limited conditions. Medicare's coverage is typically specifically limited to manual manipulation of the spine to correct subluxation. The provider must document that the service is medically necessary rather than maintenance therapy.

Multiple procedures

When multiple procedures are performed during the same visit, appropriate modifiers should be used to ensure accurate billing. If CMT is performed in addition to other therapeutic services, both services can be billed separately when properly documented.

Other relevant codes

These chiropractic CPT codes are also important to consider and learn about:

• 98941: Chiropractic manipulative treatment (CMT); spinal, 3-4 regions
• 98942: Chiropractic manipulative treatment (CMT); spinal, 5 regions
• 98943: Chiropractic manipulative treatment (CMT); extraspinal, 1 or more regions
• 97140: Manual therapy techniques, 1 or more regions, each 15 minutes
• 97530: Therapeutic activities, direct patient contact, each 15 minutes