Ultimate Guide to CPT Code 98942 for Chiropractic Billing

Chiropractic care focuses on diagnosing and treating neuromuscular conditions, primarily through spinal adjustments. This approach helps patients manage pain, improve mobility, and enhance overall well-being without surgery or medication.

To ensure appropriate billing and insurance reimbursement, chiropractic must use the correct current procedural terminology (CPT) code. One of the required codes in chiropractic billing is CPT code 98942. In this guide, we will notice its use, documentation requirements, and reimbursement strategies so that you can help maximize revenue and avoid claim denial.

What is CPT Code 98942?

CPT Code 98942 is used for chiropractic manipulative treatment (CMT) involving all five spinal regions:

Cervical region (neck, including Atlanta-occipital joint)
Thoracic region (upper back, including cost vertebral and cost transverse joints)
Lumbar region (lower back)
Sacral region (sacrum)
Pelvic region (sacroiliac joint)

This code is specifically for sessions where all five regions of the spine are adjusted. Using this code incorrectly can result in claim denials and compliance issues.

Documentation Requirements for CPT Code 98942

Proper documentation is crucial for justifying the necessity of the 98942 chiropractic code. Chiropractors should include:

Patient history and reason for treatment
Review of imaging or prior examinations
Physical examination findings
Treatment plan and goals
Progress tracking and patient response

Incomplete or vague documentation increases the risk of denials. Insurance companies require detailed records proving the medical necessity of adjusting all five spinal regions.

Common Challenges with CPT Code 98942

Misuse of the Code

One common mistake is billing 98942 when fewer than five regions are treated. For instance, if only the cervical, thoracic, and lumbar areas are adjusted, CPT Code 98941 should be used instead.

Claim Denials Due to Lack of Medical Necessity

Insurance providers may deny claims if documentation does not clearly show why adjustments were needed in all five spinal regions. To prevent this:

Document patient symptoms
Record the clinical reasoning for treating all five regions
Use ICD-10 diagnosis codes that justify

Incorrect Modifier Usage

For Medicare and many private insurers, chiropractic manipulations must include the AT modifier (Active Treatment) to indicate that the service is medically necessary. Claims without this modifier may be denied or classified as maintenance care, which is not reimbursed.

Optimizing Reimbursement for CPT Code 98942

Follow Best Billing Practices

Double-check that 98942 is the correct code for the number of regions treated
Ensure all documentation is complete before submitting claims
Work with experienced medical billing professionals to minimize errors

Stay Updated on Chiropractic Coding Rules

CPT coding guidelines and insurance policies change frequently. To stay compliant, chiropractors and billing staff should regularly review updates to Medicare, private insurance, and Medicaid rules.

Train Staff on Coding Accuracy

Billing errors often occur due to a lack of training. Investing in staff education on chiropractic CPT codes can help prevent denials and delays in reimbursement.

Communicate with Insurance Providers

If a claim is denied, follow up with the insurance provider to understand the reason. You can also file an appeal with additional documentation if necessary.

Key Takeaways for Using CPT Code 98942 Effectively

Use 98942 only when all five spinal regions are treated
Ensure thorough documentation to justify medical necessity
Use the AT modifier when required
Stay informed about coding updates to avoid claim denials
Train your billing staff on correct coding practices

By following these best practices, chiropractic clinics can maximize reimbursement, avoid compliance issues, and provide quality patient care without financial failures.

Need help with chiropractic billing?

Management of chiropractic billing can be challenging, but express medical billing is to help here. Our team specializes in accurate coding, submission of claims, and reimbursement optimization. Contact us today to streamline your practice billing and focus on what your patients have the most!

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