Chiropractic CPT Codes are published and maintained by the American Medical Association and are one of the most important code sets for chiropractors to become familiar with.
Each CPT codes contain five alpha-numeric characters used to describe all the evaluations, diagnostic tests and medical procedures performed by a chiropractor on a patient. As you might imagine, this code set is extremely large and contains tens of thousands of medical procedures.
CPT Codes & Chiropractic
While there are three primary categories of CPT codes, most chiropractors use only Category 1 codes. CPT codes in this category describe procedures performed by healthcare providers in inpatient and outpatient offices. Some examples common CPT codes used by chiropractors include:
Chiropratic Modifier Codes
There are also two character modifiers that can be attached to certain codes to tell insurance companies that there is something different about the services related to the CPT code being billed. Codes that require a modifier, but are billed without one, will be rejected by the insurance company.
While there are several modifiers, the two most commonly used in modifiers by chiropractors are modifier 25 and modifier 59. The key to using modifiers to ensure maximum reimbursement is to understand each payer’s specific recommendations on the matter.
Chiropratic CPT Codes List
CPT codes are an integral part of the chiropractic billing process. Chiropractic billing codes tell the insurance company what procedures the chiropractor is performing and would like to be reimbursed for. Insurance companies use CPT codes to track health data and measure the prevalence and value of certain medical procedures.
Unlike medical providers, chiropractors use a limited set of CPT codes. There are only four codes for chiropractic manipulative treatment – all of which are based on the spinal regions treated:
When billing for chiropractic manipulation or adjustments, the accompanying documentation must reference the proper number of spinal regions per code. For example, if billing CPT code 98941, your documentation should reference 3-4 spinal regions with dysfunction or misalignment. Documenting dysfunction in only 1-2 spinal regions would result in a rejected claim from the insurance carrier.
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Here is a list of the most commonly billed chiropractic CPT codes
Chiropractic CPT Code Cheat Sheet
By making your own list of commonly-used CPT codes, you’ll begin to discover patterns in the types of conditions you see or in the therapeutic needs your patients have. From there, you can learn how to quickly use these codes, while also providing the proper documentation to get reimbursed for your services.
While creating your coding cheat sheet, you may want to also create a list of codes that cause the most trouble for your office. By looking for problem codes, you may identify areas where additional coding training is needed or additional documentation is necessary.
Chiropractic Billing Codes - Tips & Advice
Chiropractic billing can be complicated. Successful reimbursement depends on more than just the proper CPT codes. Insurance reimbursement is contingent upon the patient’s coverage, proper documentation, and finally, using the proper billing codes.
These tips that will help improve your financial process and insurance reimbursements.
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ChiroFusion’s chiropractic billing software makes it easy to search and bill for chiropratic CPT codes, and to properly document patient encounters. Our integrated, cloud-based software auto-generates claim files each time a SOAP note is signed. This not only saves time and money, but can reduce erroneous billing errors. Claims can be submitted directly from within our chiropractic billing software to the clearinghouse in one click. Contact ChiroFusion today to find out how our EHR software can help to streamline your practice’s billing and maximize revenue.
Chiropractic CPT Codes FAQ
Q. What are chiropractic billing codes?
A. Chiropractic billing codes, known as CPT codes, are numbers assigned to treatments or services that a chiropractor may provide to a patient including medical and diagnostic services.
Q. What are chiropractic modifiers?
A. Chiropractic modifiers can be attached to certain CPT codes to tell insurance companies that there is something different about the services related to the CPT code being billed. While there are several modifiers, the two most commonly used in modifiers by chiropractors are modifier 25 and modifier 59.
Q. What CPT codes do chiropractors use?
A. While there are three primary categories of CPT codes, most chiropractors use only Category 1 codes. The most common CPT codes used by chiropractors are CPT Code 98940, CPT Code 98941, CPT Code 98942, and CPT Code 98943.
Q. What are the most commonly billed chiropractic CPT codes?
A. The most commonly billed chiropractic CPT codes are CPT Code 98940 Chiropractic manipulative treatment (CMT); Spinal, 1-2 regions, CPT Code 98941 Chiropractic manipulative treatment (CMT); Spinal, 3-4 regions, and CPT Code 98942 Chiropractic manipulative treatment (CMT); Spinal, 5 regions.
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Medicare rules and coding guidelines for chiropractic.
Chiropractic billing proper use of E/M CPT codes 99201-99204.
Chiropractic CPT procedural codes – ASH.
CMT coding guidelines for chiropractic.
Chiropractic riders: procedure codes and coverage codes.