Chiropractic CPT Codes – How to Bill Accurately & Avoid Denials

As a chiropractic billing auditor with 10+ years of experience, I’ve helped clinics recover over $1M in denied claims. Let’s break down the top chiropractic CPT codes, Medicare rules, and modifier strategies—with real-world examples—to keep your revenue flowing.

What Are Chiropractic CPT Codes?

CPT codes standardize billing for chiropractic services, from spinal adjustments to therapeutic modalities. Key categories:

Spinal Manipulation: 98940 (1-2 regions), 98941 (3-4), 98942 (5+).
Therapies: 97035 (ultrasound), 97140 (manual therapy).
Exams: 99202-99215 (office visits based on complexity).

Example: A patient with lower back pain might be billed as 98941 (3-4 regions adjusted) + 97110 (therapeutic exercise).

Top 10 Chiropractic CPT Codes for 2024

98940: Spinal manipulation (1-2 regions).
98941: Spinal manipulation (3-4 regions) – most commonly used.
98942: Spinal manipulation (5+ regions).
97035: Ultrasound therapy (e.g., soft tissue injury).
97140: Manual therapy (e.g., myofascial release).
99213: Office visit (moderate complexity).
97112: Neuromuscular re-education.
97535: Self-care/home management training.
97014: Electrical stimulation (unattended).
G0151: Medicare therapeutic massage (if state-covered).

Case Study: A Michigan clinic reduced denials by 50% by switching from 98942 to 98941 for most patients.

Medicare Chiropractic CPT Codes - Critical Rules

Covered Codes: Only 98940-98942 (spinal adjustments for subluxation).
Documentation Required:
- X-rays or physical exam proving subluxation.
- AT Modifier: Append to 98940-98942 (e.g., 98941-AT).
Non-Covered: Therapies (97035, 97140) are *patient-paid* under Medicare.

Example: Billing Medicare for 98941 without -AT or proof of subluxation = automatic denial.

Modifiers for Chiropractic Billing

-AT: Mandatory for Medicare spinal adjustments.
-59: Distinct procedural service (e.g., 98941 + 97140-59).
-25: Significant, separately identifiable E/M service (e.g., 99213-25 + 98941).

Denial Alert: Using -59 instead of -25 for E/M services triggers audits.

3 Common Denial Reasons & Fixes

Missing -AT Modifier: Medicare rejects 98940-98942 without it.
- Fix: Train staff to append -AT automatically.
Bundling Errors: Medicare won’t pay 97035 with 98941.
- Fix: Collect patient payment upfront for non-covered therapies.
Incorrect Leveling: Using 98942 for 3 regions (should be 98941).
- Fix: Audit charts to match regions adjusted to codes.

Chiropractic Billing Codes – Tips & Advice

Navigating chiropractic CPT codes is simply one part of the medical billing process. To improve your economic outcomes, keep the subsequent recommendations in mind:

Verify coverage: Not all coverage plans cover the same processes, even from the identical service. Be certain to test every patient’s coverage before their appointment.
Complete pre-authorizations: For a few services, especially in chiropractic care, pre-authorization can be required to ensure compensation.
Analyze denied claims: Regularly reviewing denied claims assists you in identifying developments and connecting recurring troubles in your billing process.
Understand Medicare requirements: Medicare most effectively reimburses chiropractors for the right CPT codes, together with 98941 (CMT, spinal; 3-four areas). Familiarize yourself with Medicare’s suggestions to avoid denials.

By learning CPT codes for chiropractic care, you can increase your exercise’s financial suitability and ensure compliance with insurance and Medicare guidelines.

Conclusion

Understanding and properly using chiropractic CPT codes is crucial for easy billing operations and maximizing repayment from insurance businesses. By familiarizing themselves with the most generally used codes and studying a way to practice modifiers, chiropractors can enhance their exercise’s financial health and reduce claim denials.