Chiropractic CPT Codes

Chiropractic CPT Codes – What Chiropractors Need To Know

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:

  • CPT Code 99203 – Initial Exam
  • CPT Code 98940 - Chiropractic manipulative treatment (CMT); spinal, 1-2 regions
  • CPT Code 97110 – Therapeutic Exercise

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:

  • CPT Code 98940 Chiropractic manipulative treatment (CMT); Spinal, 1-2 regions
  • CPT Code 98941 Chiropractic manipulative treatment (CMT); Spinal, 3-4 regions
  • CPT Code 98942 Chiropractic manipulative treatment (CMT); Spinal, 5 regions
  • CPT Code 98943 Chiropractic manipulative treatment (CMT); Extraspinal, 1 or more regions

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

  • CPT Code 99202 - Evaluation and Management, Initial Visit
  • CPT Code 99203 - Evaluation and Management, Initial Visit
  • CPT Code 99204 - Evaluation and Management, Initial Visit
  • CPT Code 99212 - Evaluation and Management, Established Patient
  • CPT Code 99213 - Evaluation and Management, Established Patient
  • CPT Code 99214 - Evaluation and Management, Established Patient
  • CPT Code 97140 - Manual Therapy
  • CPT Code 97110 - Therapeutic Exercise
  • CPT Code 97750 - Physical Performance Examination
  • CPT Code 99211 - Re-evaluation
  • CPT Code 97112 - Neuromuscular Re-education
  • CPT Code 97530 - Therapeutic Activities
  • CPT Code 97010 - Hot/Cold Packs
  • CPT Code 97014 - Electrical Stimulation (Unattended)
  • CPT Code 97035 - Ultrasound/Phonophoresis
  • CPT Code 97161 - PT Evaluation: Low Complexity
  • CPT Code 97116 - Gait Training
  • CPT Code 97162 - PT Evaluation: Moderate Complexity
  • CPT Code 97535 - Self Care/Home Management Training
  • CPT Code 97032 - Electrical Stimulation (Manual)
  • CPT Code 97012 - Mechanical Traction
  • CPT Code 97113 - Aquatic Exercise
  • CPT Code 97124 - Massage
  • CPT Code 97018 - Paraffin Bath
  • CPT Code 97022 - Whirlpool
  • CPT Code 97026 - Infrared Light
  • CPT Code 97033 - Iontophoresis
  • CPT Code 97039 - Laser/Other
  • CPT Code 72020 - Radiologic examination, spine, single view, specify level
  • CPT Code 72040 - Radiologic examination, spine, cervical; two or three views
  • CPT Code 72070 - Radiologic examination, spine; thoracic, two views
  • CPT Code 72072 - Radiologic examination, spine; thoracic, three views
  • CPT Code 72100 - Radiologic examination, spine, lumbosacral; two or three views
  • CPT Code 72170 - Radiologic examination, pelvis; one or two views
  • CPT Code 72190 - Radiologic examination, pelvis; complete, minimum of three views
  • CPT Code 72200 - Radiologic examination, sacroiliac joints; less than three views
  • CPT Code 72220 Radiologic examination, sacrum and coccyx; minimum of two views

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.

  • Understand your patients insurance coverage. Two patients can have the coverage from the same company, but their insurance contract can be different. Conversely, one insurance carrier might reimburse for a specific CPT while another one will deny it. Checking eligibility prior to every new patient appointment is therefore the essential first step in the claim revenue cycle.
  • Always complete pre-authorizations before starting treatment (if applicable). Even if a patient has the chiropractic benefits on their plan, your claims may be denied if there are pre-authorization requirements in place.
  • Analyze denied claims. One of the biggest issues that negatively affect revenue is denied claims. In fact, according to the Government Accountability Office, up to 25% of insurance claims are denied. By analyzing your denials, you can identify patterns that can be corrected.
  • Understand Medicare's billing and documentation requirements. Chiropractors have one of the highest error rates when billing Medicare. This rate includes rejected and denied claims. The only chiropractic CPT codes covered by Medicare are 98941, 98942 and 98943. All other CPT codes billed to Medicare will be denied. Also, when submitting a claim to Medicare for manipulation, you must include the Acute Treatment (AT) modifier if you expect to get paid.​
  • Properly document your patient encounters. To minimize the odds of triggering an audit and possibly paying penalties and fines, be sure to properly document your encounters. Your SOAP notes should indicate the need for treatment, and include treatment goals, objective measures for patient progress, the patient’s progression and the treatment plan. The latter should include duration and frequency. When billing Medicare, be sure all documentation is complete and according to established guidelines.​

How ChiroFusion Can Help With Chiropractic CPT Codes

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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