Top 10 CPT Codes and Modifiers for Chiropractic Medical Billing in 2024

Current Procedural Terminology (CPT) codes, developed by the American Medical Association, are a standardized coding system used by healthcare professionals to document and report medical, surgical, and diagnostic procedures and services. Similarly, in the field of chiropractic medical billing, specific CPT codes and modifiers are used to categorize and describe the various procedures performed by chiropractors.

Understanding these codes is crucial for maintaining compliance, minimizing billing errors, and ensuring accurate reimbursement for services provided. This article will provide insights into the top 10 CPT codes and modifiers used in chiropractic medical billing.

Top 10 CPT Codes in Chiropractic Medical Billing

1. 98940: Chiropractic Manipulative Treatment (CMT)

This code is used to bill for spinal manipulation of one to two regions. It’s the most commonly used code by chiropractors and usually represents the primary therapeutic procedure.

2. 98941: CMT Involving 3-4 Regions

This CPT code applies to spinal manipulation involving 3-4 spinal regions. A region could be defined as cervical, thoracic, lumbar, sacral, or pelvic.

3. 98942: CMT Involving 5 Regions

Used when a chiropractor manipulates five spinal regions, this is the most extensive CMT code.

4. 97010: Application of a Modality to One or More Areas

This code is used when providing patient therapy using modalities like hot or cold packs.

5. 97012: Mechanical Traction Therapy

This code is used when a chiropractor applies a force to elongate soft tissues and relieve pressure on compressed joints.

6. 97110: Therapeutic Exercises

This code represents the provision of therapeutic exercises designed to develop strength and endurance, range of motion, and flexibility.

7. 97112: Neuromuscular Re-education

This code is used to bill for services when a patient requires exercises or movement practice to restore balance, coordination, kinesthetic sense, posture, and proprioception.

8. 97140: Manual Therapy Techniques

When chiropractors apply manual therapy techniques such as mobilization/manipulation, manual lymphatic drainage, or manual traction, they can use this code.

9. 97530: Therapeutic Activities

This code is used to bill for direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance).

10. 99202-99205 and 99212-99215: Evaluation and Management Services

These codes are used to bill for various levels of patient evaluation and management services.

Top Modifiers in Chiropractic Medical Billing

Modifiers offer additional information or context about a procedure beyond the code itself. Here are some commonly used modifiers in chiropractic practice.

1. Modifier 25

This modifier is used when a patient’s visit involves a significant, separately identifiable evaluation and management service.

2. Modifier 59

Modifier 59 is used to indicate that two or more procedures were performed during the same visit but were separate and distinct from each other.

3. Modifier 51

This is used when multiple procedures are performed during the same visit by the same provider. It indicates that these procedures are distinct and independent from each other.

4. Modifier GP

This modifier is used to indicate that services rendered are part of outpatient physical therapy.

5. Modifier AT

This modifier indicates that services provided are acute treatment, signifying that the care rendered is necessary for an active therapy plan.

Understanding and using the correct CPT codes and modifiers in chiropractic medical billing is vital for accurate documentation, compliance, and reimbursement. However, keeping up with the complex coding system can be challenging. Therefore, investing in continual learning and potentially utilizing automated billing software can help ensure a smooth, efficient billing process. Remember, accurate coding not only safeguards the financial health of the practice but also ensures that patients receive the appropriate care documented in their health records.

Direct Patient-Chiropractor Care CPT Codes: A Deep Dive

In the field of chiropractic care, Current Procedural Terminology (CPT) codes play a critical role in the billing and coding process. These alphanumeric codes, developed and maintained by the American Medical Association, are used to describe the specific services rendered by healthcare providers. Direct patient-chiropractor care CPT codes are particularly important as they depict the hands-on services a chiropractor provides to their patients. This article delves into the most frequently used direct patient-chiropractor care CPT codes.

1. 98940, 98941, and 98942: Chiropractic Manipulative Treatment (CMT)

The backbone of chiropractic care, CMT is represented by three primary codes, based on the number of spinal regions treated during a patient’s visit:

• 98940: Manipulation treatment for 1-2 spinal regions.
• 98941: Manipulation treatment for 3-4 spinal regions.
• 98942: Manipulation treatment for all 5 spinal regions.

A spinal region is defined as one of the following: cervical, thoracic, lumbar, sacral, or pelvic.

2. 97110: Therapeutic Exercises

This code is used when a chiropractor prescribes and guides a patient through therapeutic exercises. The aim of these exercises is typically to develop strength and endurance, range of motion, and flexibility.

3. 97112: Neuromuscular Re-education

Neuromuscular re-education involves exercises designed to regain movement, balance, coordination, kinesthetic sense, posture, and proprioception. This code is utilized when such services are provided.

4. 97140: Manual Therapy Techniques

When a chiropractor performs manual therapy techniques, they may use this code. These techniques could include mobilization/manipulation, manual lymphatic drainage, or manual traction.

5. 97530: Therapeutic Activities

The 97530 CPT code is used for billing direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance).

6. 97012: Mechanical Traction Therapy

This code covers services when a chiropractor applies a force to stretch certain parts of the body to relieve pressure on compressed joints.

7. 99201-99205 and 99211-99215: Evaluation and Management Services

These codes represent different levels of patient evaluation and management services that are conducted in a chiropractic setting. They range from brief check-ups to more complex visits.

Direct patient-chiropractor care is the essence of chiropractic practice. Therefore, understanding and correctly using the corresponding CPT codes for billing purposes is crucial. This not only ensures a smoother, more effective billing process but also promotes accurate and consistent patient records across the healthcare system.

By providing detailed descriptions of services provided, these codes help facilitate communication between healthcare providers, patients, and insurance companies. They are an integral part of the health care system, contributing to effective care delivery, administration, and research. It’s important for all chiropractors to stay updated on changes to CPT codes and their use to ensure the most accurate and efficient coding for their practice.

The Benefits of Chiropractic Insurance Billing

Introduction

Insurance billing is a vital component of every healthcare practice, including chiropractic care. The effective use of insurance billing in chiropractic practices facilitates the reimbursement process, allowing practitioners to receive compensation for their services while making these services more accessible for patients. The process, while sometimes complex, brings about numerous benefits.

1. Streamlined Cash Flow

One of the primary benefits of chiropractic insurance billing is the consistent and streamlined cash flow it provides. By accurately submitting insurance claims, chiropractors can ensure a steady flow of income that maintains the financial stability of the practice.

2. Expanded Patient Base

Insurance billing enables chiropractors to expand their patient base. Many patients rely on insurance to afford healthcare services, including chiropractic care. By accepting insurance, chiropractors make their services accessible to a broader range of individuals.

3. Improved Patient Satisfaction and Retention

The ability to accept insurance increases patient satisfaction by easing their financial burden. Patients are more likely to return to a chiropractor who accepts their insurance, thus improving patient retention rates.

4. Accurate Record Keeping

Insurance billing mandates accurate and detailed record-keeping, as every service provided must be accounted for. This leads to better patient management, assists with future audits or inspections, and allows chiropractors to track their services and patient progress effectively.

5. Reduces Payment Delays

With an efficient and well-managed insurance billing system, chiropractors can reduce the incidence of payment delays. This includes accurate use of CPT codes and modifiers, correct patient information, and prompt claim submission. All of these factors contribute to quicker claim approvals and fewer denials.

6. Facilitates Communication with Other Healthcare Providers

The use of standardized CPT codes in insurance billing also promotes consistent communication among healthcare providers. When different providers treat a patient, they can understand the procedures and treatments a patient has received through these universally recognized codes.

Get Started Today!

While chiropractic insurance billing can be complex and requires continuous learning and adaptation, its benefits are undeniable. It contributes to the financial stability of the practice, improves patient satisfaction, and promotes thorough and accurate record keeping. However, to maximize these benefits, chiropractors must ensure that their insurance billing processes are accurate, timely, and efficient. This often means staying updated on changes in insurance policies and CPT codes and possibly investing in advanced billing software or professional billing services.

Author: Mike Cynar

Mike Cynar brings buyers and sellers together by producing reviews and creating non biased webpages allowing users to share their experiences on various products and services. He and his staff write informative articles related to the medical field, legal, and other small business industries.