How To Use CPT Code 98940

CPT 98940 refers to chiropractic manipulative treatment (CMT) specifically targeting one to two spinal regions. This treatment is designed to influence joint and neurophysiological function through various manipulation techniques and modalities. The procedure is typically performed by a qualified chiropractic professional who assesses the patient’s condition and applies appropriate manipulative techniques to alleviate pain, improve mobility, and enhance overall function in the affected spinal areas.

1. What is CPT code 98940?

CPT code 98940 represents chiropractic manipulative treatment (CMT) focused on one to two regions of the spine. This code is utilized when a chiropractor applies specific manipulation techniques to the spinal joints to relieve discomfort, enhance joint mobility, and improve neurophysiological function. The treatment is based on a thorough assessment of the patient’s medical history and physical condition, often involving diagnostic imaging such as X-rays to identify the areas requiring intervention. The primary goal of this procedure is to alleviate pain and restore function, making it a vital component of chiropractic care.

2. Qualifying Circumstances

This CPT code can be used when the treatment involves manipulation of one or two spinal regions. It is essential that the provider documents the specific regions treated and the techniques used during the session. Limitations may apply based on the patient’s condition, and the code should not be used if the treatment involves three or more spinal regions, in which case CPT codes 98941 or 98942 would be appropriate. Additionally, if a significant and separately identifiable evaluation and management (E/M) service is performed on the same day, it may be reported with modifier 25 appended to the E/M code, subject to payer policy.

3. When To Use CPT 98940

CPT code 98940 is used when a chiropractor performs manipulative treatment on one or two spinal regions. It is crucial to ensure that the treatment is documented accurately, including the specific spinal regions involved. This code cannot be used in conjunction with codes for three or more regions, as those require different CPT codes (98941 for three to four regions and 98942 for five regions). Providers should also be aware of payer policies regarding the use of modifier 25 for reporting additional E/M services on the same date of service.

4. Official Description of CPT 98940

Official Descriptor: Chiropractic manipulative treatment (CMT); spinal, 1-2 regions.

5. Clinical Application

CPT 98940 is applied in clinical settings where chiropractic care is provided to address musculoskeletal issues, particularly those affecting the spine. The treatment aims to relieve pain, improve joint function, and enhance the patient’s overall quality of life. Chiropractors utilize various techniques, including manual adjustments and soft tissue manipulation, to achieve these outcomes. The clinical significance of this code lies in its ability to facilitate targeted treatment for patients experiencing discomfort in specific spinal regions, thereby promoting recovery and functional improvement.

5.1 Provider Responsibilities

The provider’s responsibilities during the procedure include taking a comprehensive medical history from the patient, which helps in understanding the underlying issues. The chiropractor may perform physical examinations and, if necessary, order X-rays to visualize the spinal structures. Based on the findings, the provider develops a tailored treatment plan. During the treatment session, the chiropractor instructs the patient to lie on a specialized treatment table, ensuring comfort and proper positioning. The provider then applies manipulation techniques, which can range from gentle touches to more vigorous adjustments, depending on the patient’s needs and tolerance.

5.2 Unique Challenges