Introduction
Chiropractic care involves spinal manipulations, therapeutic exercises, and adjunctive treatments to address musculoskeletal conditions. Proper CPT coding ensures accurate reimbursement and prevents denials due to incorrect modifier use or bundling issues. This guide covers key CPT codes for chiropractic adjustments, manual therapy, and rehabilitative treatments, along with billing guidelines, modifier use, and a final reference table with CPT descriptions and RVUs.
Understanding Chiropractic Coding
- Spinal Manipulation Codes – Used for adjustments to specific spinal regions.
- Extremity Manipulation Codes – Covers adjustments to joints outside the spine.
- Therapeutic Procedures – Includes rehabilitation and adjunctive therapy services.
- Medicare Coverage – Medicare usually covers these codes when billed for somatic dysfunction diagnoses.
CPT Codes for Chiropractic Services
Spinal Manipulation CPT Codes
- 98940 – Chiropractic manipulation, 1-2 spinal regions.
- 98941 – Chiropractic manipulation, 3-4 spinal regions.
- 98942 – Chiropractic manipulation, 5 or more spinal regions.
Extremity Manipulation CPT Codes
- 98943 – Chiropractic manipulation, extraspinal (e.g., shoulder, knee, wrist).
Therapeutic & Rehabilitative Treatment CPT Codes
- 97110 – Therapeutic exercises, per 15 minutes.
- 97112 – Neuromuscular re-education.
- 97140 – Manual therapy techniques.
- 97035 – Ultrasound therapy.
- 97012 – Mechanical traction therapy.
- 97032 – Electrical stimulation, manual.
Billing Guidelines & Modifier Usage
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Common Modifiers:
- -AT – Used when spinal manipulation is performed for active treatment.
- -59 – Distinct procedural service (if multiple interventions are performed).
- -GP – Indicates services provided under a therapy plan of care.
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Bundling Considerations:
- Spinal manipulation codes (98940-98942) should not be billed with physical therapy codes (97110-97140) unless medically necessary.
- Use modifier -59 when billing manual therapy (97140) with spinal manipulation.
Common Denials & How to Avoid Them
- Medical Necessity Denials: Ensure documentation includes objective findings justifying chiropractic treatment.
- Modifier Use Issues: Append -AT modifier when reporting active treatment under Medicare.
- Duplicate Claim Rejections: Avoid billing multiple manipulation codes for the same region on the same visit unless properly justified.
Final CPT Code Table: Descriptions & RVUs
| CPT Code | Description | RVU |
|---|---|---|
| 98940 | Chiropractic manipulation, 1-2 spinal regions | 0.80 |
| 98941 | Chiropractic manipulation, 3-4 spinal regions | 1.00 |
| 98942 | Chiropractic manipulation, 5 or more spinal regions | 1.20 |
| 98943 | Chiropractic manipulation, extraspinal | 0.85 |
| 97110 | Therapeutic exercises, per 15 minutes | 0.90 |
| 97112 | Neuromuscular re-education | 0.85 |
| 97140 | Manual therapy techniques | 0.95 |
| 97035 | Ultrasound therapy | 0.70 |
| 97012 | Mechanical traction therapy | 0.65 |
| 97032 | Electrical stimulation, manual | 0.75 |
Conclusion
Accurate CPT coding for chiropractic services is essential for maximizing reimbursement and preventing denials. Understanding modifier use, bundling rules, and payer-specific guidelines will help ensure accurate claims.
If this guide was useful, check out our other manual therapy CPT coding guides on physical therapy, osteopathic manipulation, and sports medicine!