Chances are that after seeing patients with chronic pain or life-long impairments and creating accurately coded medical claims for months, it is now you who needs the services of a chiropractor.
While we may not be able to provide physical relief, we can definitely reduce some of your mental workload with this detailed guide on the most used chiropractic CPT codes in 2024.
We have streamlined the comprehensive CPT code descriptions and the coding best practices to expedite medical billing for your chiropractic practice and help you submit first-pass claims for an optimized revenue cycle.
Let’s understand the most used CPT codes for chiropractic procedures in 2024 and solve the coding conundrum!
Chiropractic CPT Codes for Evaluation & Management Services
First-time evaluations and constant management are integral to ensuring the effectiveness of chiropractic procedures. You cannot decide on the most suitable treatment method without analyzing your patient’s condition, and neither can you treat the pain or impairment without constantly monitoring the effectiveness of the chosen technique.
Hence, the following evaluation and management (E/M) CPT codes for chiropractic procedures are worth noting.
CPT Codes 99202-99205 for New Patients E/M Visits
This CPT code range covers timed E/M visits of new patients seeking chiropractic services. For example, code 99202 is reported when the chiropractor meets a new patient for 15 minutes, and CPT code 99205 is used for visits lasting up to an hour (60 minutes).
CPT 99212-99215 for Established Patients E/M Visits
However, when a regular or established patient visits the chiropractor for evaluation and management, attention must be paid to the CPT code range 99212-99215. Again, all four codes in this range are time-based and involve straightforward to high-level decision-making.
For example, CPT code 99212 is used when the chiropractor spends 10 minutes with a returning patient for a general follow-up. In contrast, code 99215 is reported when the provider spends 40 minutes or more with a returning patient and performs a thorough evaluation.
CPT Codes for Chiropractic Manipulation Treatment (CMT)
The main focus of chiropractic manipulation treatments (CMT) is to correct the spine’s alignment and reduce pain. A licensed chiropractor uses hands or small instruments to apply controlled pressure on the joints.
The following chiropractic CPT codes cover manual manipulation of the spinal and extraspinal regions.
CPT Code 98940 – CMT Spinal, 1-2 Regions
98940 is one of the most frequently reported CPT codes for chiropractic. It is used in medical claims when the provider wants to collect payment for applying chiropractic manipulation treatment (CMT) on one or two spinal joints. The technique improves neurophysiological function and relieves pain.
CPT Code 98941 – CMT Spinal, 3-4 Regions
98941 is another chiropractic CPT code for spinal manipulation. It is reported when the provider applies pressure on three or four regions in the spine by hand or using a specialized instrument, e.g., the Activator Adjusting Instrument (AAI).
CPT Code 98942 – CMT Spinal, 5 Regions
When a patient experiences pain and discomfort all over the spine (5 or more regions), the chiropractor applies pressure to the affected joints.
To report this procedure and secure reimbursement for it, he uses chiropractic CPT code 98942. The technique is effective in improving spinal motion and neurophysiological function.
CPT Code 98943 – CMT Extraspinal, 1 or More Regions
98943 is a CPT code for a chiropractic procedure not covered by Medicare. But since private insurers may offer coverage for it, we have mentioned it.
The technique involves manual manipulation of one or more extraspinal regions, e.g., the head, rib cage, abdomen, and lower and upper extremities, for pain relief and improved motor function.
Chiropractic CPT Codes for Methods of Treatment
In this section, we will cover some other treatment methods used by chiropractors for pain relief and improved body functions.
The common chiropractic CPT codes for additional methods of treatment are as follows.
CPT Code 97110 – Therapeutic Exercises for Motor Functions
97110 is a CPT code for chiropractic procedures targeting patient’s mobility and fitness level. The provider uses this code when he helps the patient perform therapeutic exercises, like aerobics and balancing, to recover from surgeries or to manage injury-related disabilities.
Such exercises can also be ordered for overall health improvement during pregnancy or conditions like osteoporosis.
CPT Code 97112 – Neuromuscular Re-education
Chiropractic CPT code 97112 is also reported for therapeutic exercises. However, the exercises are performed this time to increase communication between the brain and the affected muscles, hence the term neuromuscular re-education.
The interventional exercises or activities improve balance, coordination, posture, and kinesthetic sense, restoring the patient’s ability to perform physical work without hindrance.
CPT Code 97124 – Therapeutic Massage
97124 is another commonly used, time-specific CPT code for chiropractic procedures. It is used to bill 15 minutes of therapeutic massage involving various techniques like tapotement, petrissage, and effleurage.
The massage therapist applies light or heavy pressure on the affected tissues and muscles using the palms, fingers, or thumbs to restore blood circulation and reduce tension.
CPT Code 97140 – Manual Therapeutic Techniques
This time-based code is used to report 15 minutes of manual therapeutic techniques on one or more regions. The chiropractor uses controlled hand movements and pressure to correct various disorders affecting the joints and soft tissues.
The therapy targets tissue repair, joint movement, realignment, traction, and lymphatic drainage for relieving chronic pains.
CPT Code 97150 – Group Therapy Techniques
Chiropractic CPT code 97150 is used to report group physical therapies. A licensed professional/therapist supervises and directs the activities for two or more patients simultaneously.
He may use techniques like aquatic therapy and operant conditioning to restore the body’s motor functions after an injury, surgery, or impairment.
Chiropractic CPT Codes for Modalities
Modalities for chiropractic procedures are any therapeutic tools or equipment that treat pain and discomfort caused by injuries, surgeries, or chronic conditions.
Hence, several CPT codes for chiropractic procedures involve tools, like ultrasound machines, electrodes, hot/cold compresses, and mechanical tractions, to treat pain and dysfunction. We have listed the most common ones with their explanations below.
CPT Code 97010 – Hot or Cold Packs Therapy
97101 is a chiropractic CPT code for supervised physical medicine and rehabilitation modalities. It is used when the provider wants to bill for physical therapy involving the application of hot or cold compresses on a specific area of the body to treat muscular pain, injuries, inflammation, or conditions like Arthritis.
CPT Code 97012 – Mechanical Traction Therapy
Chiropractic CPT code 97012 is used for mechanical traction. It is a highly successful treatment method for dislocations, herniated discs, and general but persistent pain in the neck, arms, back, and legs. It can also be used to effectively treat conditions like carpel tunnel syndrome and degenerative joint disease (DJD).
The chiropractor uses a device called mechanical traction to pull various body parts, such as the neck and the vertebrae, and relieve nerve root impingement. The force may be applied intermittently or consistently to widen the intervertebral foramen and to relieve pain. The procedure also helps improve fluid circulation in spinal discs.
CPT Code 97014 – Electrotherapy
Medical conditions and traumas, such as head or spinal cord injury after a car accident, can often result in the malfunctioning of body parts. A physical therapist uses electrotherapy to restore the body’s normal functions and to collect reimbursement for this procedure, the chiropractic CPT code 97104 is reported.
During this procedure, the provider applies electrical currents to nerves or muscles affected by the injury and causes them to contract. Frequent muscle contraction generates force and movement in the body.
CPT Code 97032 – Electrical Stimulation
97032 is also a procedural code for electrotherapy. However, it is a time-based chiropractic CPT code and is used when the provider wants to charge for 15 minutes of electrical stimulation.
The physical therapist places electrodes on the affected area and passes electrical currents to the muscles to stimulate or expand and contract them. The procedure requires constant supervision, and the provider may vary the intensity of electrical currents for effective treatment. It helps restore the normal functioning of muscles and strengthens them.
The overall result of this electrical stimulation can be improved blood circulation, relief from muscle pain, and improved performance during physical activities.
CPT Code 97035 – Ultrasound Therapy
Chiropractic CPT code 97035 is another time-based code that requires constant attention of the physical therapist. The attending therapist uses high-frequency sound waves (ultrasound therapy) to generate heat and heal, strengthen, or relax strained muscles.
It is generally performed when patients experience muscle pain or inflammation or want to improve blood circulation in the region after an injury or disease.
Chiropractic Coding Guidelines
Medical coding is a lot more than just using the correct chiropractic CPT codes on reimbursement claims. You must follow the insurance payers’ policies and the industry-wide accepted chiropractic coding guidelines to prevent claim denials and revenue leakages.
For example, you must:
Verify Patient Eligibility
Before performing chiropractic procedures, you must check if the patient’s insurance plan covers the services you are about to provide. It is known as patient eligibility verification. You can ask for the patient’s medical insurance details to find the covered and uncovered services.
You must also bear in mind that the insurance coverages for your chiropractic services will vary from payer to payer. For example, Medicare does not cover CMT for extraspinal regions (CPT code 98943). However, some commercial insurance payers may offer reimbursement against it.
Seek Prior Authorization
It is a good practice to get pre-authorization for physical therapies and related services from your patient’s insurance company. The process ensures that the service is pre-approved by the insurance payer. Hence, they cannot deny reimbursement for it on the grounds that they do not cover it.
Document Patient Encounters
You must maintain complete and accurate documentation for all patient encounters, be it the E/M visits or the chiropractic procedures. The documentation helps prove the medical necessity of services, and you can use the complete records to notify insurers that the equipment used was expensive and requires compensation.
Moreover, all insurers ask for supporting documents to corroborate the information on the medical claims. It helps them check whether or not the payment the provider wants is just.
Use Chiropractic Modifiers
When needed, use modifiers with your chiropractic CPT codes to provide more details to the insurance payer. The most commonly used modifiers in chiropractic coding and billing are:
- Modifier AT: Indicates that the chiropractor provided an acute treatment and the rendered care was part of an active therapy plan.
- Modifier GP: Indicates that the procedure was performed by a qualified physical therapist.
- Modifier 25: Indicates that a separate E/M service was provided on the same day as the other procedure performed by the same physician.
- Modifier 51: Indicates that the same provider performed multiple procedures on the same day.
- Modifier 59: Indicates that all the procedures performed on the same day are distinct.
Contact Professionals Coders
Medical coding is a complex and time-consuming process. The paperwork requires a couple of hours each day and can hinder your ability to experience work-life balance. But when you let professionals be in charge of the chiropractic coding and billing, error-free claim submissions and complete payment collections become a done deal.
You can outsource chiropractic billing services by choosing one of the best healthcare RCM companies to access certified professional coders (CPCs) and reduce your CPT coding workload to a bare minimum.
Final Word
The most common CPT codes for chiropractic procedures range from 97010 to 99215 and include specialized techniques as well as general office visits for evaluation and management.
Besides using the correct CPT code, chiropractors must adopt coding best practices, like complete documentation, patient eligibility verification, pre-authorization, and modifier usage, to submit clean claims and prevent denials.
We understand that managing everything on your own can be overwhelming. Invest in Medibill MD’s tailored medical coding services to improve the revenue cycle management of your chiropractic practice.
