CPT 98940 refers to chiropractic manipulative treatment (CMT) involving one to two spinal regions, and this article will cover its description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.
1. What is CPT 98940?
CPT 98940 is a medical billing code used to describe chiropractic manipulative treatment (CMT) that targets one to two spinal regions. This code is utilized by medical professionals, specifically chiropractors, to bill for the services they provide to patients who require spinal manipulation for various health conditions.
2. 98940 CPT code description
The official description of CPT code 98940 is: “Chiropractic manipulative treatment (CMT); spinal, 1-2 regions.”
The 98940 procedure involves the following steps:
- The chiropractor takes a detailed medical history from the patient.
- X-rays of the target anatomical site may be taken if necessary.
- The chiropractor decides on a course of treatment based on the initial investigation.
- The patient is instructed to lie down on a special treatment table adjusted to their height.
- The chiropractor performs therapy ranging from light touching to vigorous manipulation and massaging on one to two spinal regions.
- The treatment course typically requires several sessions with the chiropractor for completion.
4. Qualifying circumstances
Patients who are eligible to receive CPT code 98940 services are those experiencing pain, discomfort, or limited mobility in one to two spinal regions due to various health conditions. These conditions may include, but are not limited to, spinal misalignments, muscle tension, joint dysfunction, or nerve irritation. A thorough examination and evaluation by a qualified chiropractic professional are necessary to determine if CPT 98940 is the appropriate treatment for the patient’s specific condition.
5. When to use CPT code 98940
It is appropriate to bill the 98940 CPT code when a chiropractor performs chiropractic manipulative treatment on one to two spinal regions to address the patient’s health condition. The treatment should be medically necessary and supported by proper documentation, including a detailed medical history, examination findings, and a treatment plan outlining the frequency and duration of the CMT sessions.
6. Documentation requirements
To support a claim for CPT 98940, the following information needs to be documented:
- Patient’s medical history, including any relevant past treatments or surgeries.
- Results of the physical examination, including any positive findings related to the patient’s condition.
- X-ray or imaging results, if applicable.
- A detailed treatment plan outlining the frequency and duration of the CMT sessions, as well as the specific spinal regions being targeted.
- Progress notes for each treatment session, including the patient’s response to the therapy and any changes in their condition.
7. Billing guidelines
When billing for CPT code 98940, it is essential to follow the appropriate guidelines and rules to ensure accurate reimbursement. Some tips and codes that apply to CPT code 98940 include:
- Use modifier 25 when reporting a significant, separately identifiable evaluation and management (E/M) service performed on the same date as the CMT. Check payer policy for specific requirements.
- For CMT involving three to four spinal regions, use CPT code 98941.
- For CMT involving five spinal regions, use CPT code 98942.
- Ensure that all documentation requirements are met to support the medical necessity of the CMT services provided.
8. Historical information
CPT 98940 was added to the Current Procedural Terminology system on January 1, 1997. The code was changed on January 1, 2009, with the previous descriptor being “Chiropractic manipulative treatment (CMT); spinal, one to two regions.”
9. Similar codes to CPT 98940
Five similar codes to CPT 98940 and how they differentiate from CPT 98940 are:
- CPT 98941: This code represents CMT involving three to four spinal regions, as opposed to one to two regions in CPT 98940.
- CPT 98942: This code is used for CMT involving five spinal regions, which is more extensive than the one to two regions covered by CPT 98940.
- CPT 98943: This code is for chiropractic manipulative treatment of the extremities, rather than the spinal regions addressed by CPT 98940.
- CPT 97140: This code is for manual therapy techniques, such as mobilization or manipulation, which may be performed by various healthcare providers, not just chiropractors.
- CPT 97112: This code is for neuromuscular reeducation, a different type of therapy that focuses on improving movement, balance, and coordination.
Here are 10 detailed examples of CPT code 98940 procedures:
- A patient with chronic neck pain receives CMT targeting the cervical spine region.
- A patient with lower back pain undergoes CMT focusing on the lumbar spine region.
- A patient with pain in both the neck and lower back receives CMT targeting both the cervical and lumbar spine regions.
- A patient with a history of spinal misalignments undergoes CMT to address subluxations in the thoracic spine region.
- A patient with muscle tension in the neck and upper back receives CMT targeting the cervical and upper thoracic spine regions.
- A patient with joint dysfunction in the lumbar and sacral spine regions undergoes CMT to improve mobility and reduce pain.
- A patient with nerve irritation in the cervical and thoracic spine regions receives CMT to alleviate symptoms and restore function.
- A patient with a history of whiplash injury undergoes CMT targeting the affected cervical spine region to reduce pain and improve range of motion.
- A patient with sciatica receives CMT focusing on the lumbar spine region to address the underlying cause of their symptoms.
- A patient with postural imbalances undergoes CMT targeting the thoracic and lumbar spine regions to improve alignment and reduce discomfort.