98940 CPT Code Guide Maximize Your Reimbursements

Chiropractic care is essential to healthcare, relieving patients suffering from spinal issues. One of the most commonly used codes for chiropractic treatment is CPT code 98940.

Understanding this code is crucial for chiropractors and billing professionals to ensure accurate documentation, proper claims submission, and compliance with insurance requirements.

What is CPT Code 98940?

CPT code 98940 is used to report chiropractic manipulative treatment (CMT) for one or two spinal regions. It falls under the category of chiropractic manipulative treatment procedures and is essential for chiropractors providing adjustments to correct subluxations in the spine.

The goal of this treatment is to restore joint mobility, alleviate pain, and improve overall musculoskeletal function.

Key Components of CPT Code 98940

When billing for CPT 98940, chiropractors must ensure their documentation includes the following key elements:

Pre-Manipulation Assessment – A thorough examination, including a review of patient history, physical assessment, and imaging if necessary.
Chiropractic Adjustment – The actual procedure where the chiropractor manipulates the spine to correct dysfunction.
Evaluation of Treatment Effect – Notes on patient response, improvement, or any modifications to the treatment plan.

Modifiers Used with CPT Code 98940

Modifiers help clarify the nature of the medical services provided and their necessity. Some of the commonly used modifiers with 98940 include:

AT Modifier (Acute Treatment) – Used to indicate active treatment for acute or chronic subluxation. Medicare requires this modifier to process claims for chiropractic adjustments.
GA Modifier (Waiver of Liability Statement Issued) – Used when a provider has an Advance Beneficiary Notice (ABN) on file.
GZ Modifier (Item or Service Expected to be Denied) – Used when an ABN is not on file, and the service is likely to be denied.

Proper use of these modifiers is crucial to avoid claim denials and ensure reimbursement.

Challenges in Chiropractic Billing for CPT 98940

Billing for chiropractic services can present several challenges. Here are some common issues faced by practices:

Insurance Coverage Variability – Different insurance providers have varying policies on covering chiropractic services. Some strategies may only cover a limited number of appointments.
Documentation Requirements – Insufficient or incorrect documentation is a leading cause of claim denials. It’s essential to include a detailed patient history, diagnosis, treatment plan, and progress notes.
Claim Denials and Appeals – Many claims are denied due to missing modifiers, lack of medical necessity, or incorrect coding. Understanding payer requirements and submitting complete documentation can help reduce denials.
Frequency of Treatment – Some insurance companies limit the number of chiropractic treatments covered. Chiropractors must justify the medical necessity of ongoing treatment to avoid denials.

Best Practices for Chiropractic Billing and Documentation

To streamline billing and improve reimbursement rates, chiropractors should follow these best practices:

Accurate Documentation – Maintain detailed records, including pre-treatment assessments, progress notes, and responses to care.
Use Correct Modifiers – Ensure proper use of modifiers like AT, GA, and GZ to indicate medical necessity and compliance with insurance policies.
Verifies Insurance Coverage – Check patient insurance policies before treatment to avoid unexpected denials.
Stay Updated on Coding Changes – Chiropractic billing rules evolve, so it’s important to stay informed about updates from the American Medical Association (AMA) and Medicare.

Conclusion

Understanding CPT Code 98940 and following proper billing and documentation practices can help chiropractic clinics reduce claim denials and optimize revenue. By ensuring compliance with insurance policies and keeping accurate patient records.

Chiropractors can focus on delivering quality care while maintaining financial stability. Implementing a streamlined chiropractic billing process and staying updated with the latest regulations will ensure smoother claims processing and improved reimbursement rates.

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