(2023) CPT Code 98941 | Description, Guidelines, Reimbursement, Modifiers & Examples
CPT code 98941 may be used when chiropractic services are performed to treat one to five spinal areas. The service is usually furnished on the target area by hand and has small tools to move gently and realign the body. Chiropractors use these codes to report manual treatment that aids in fixing joints and neuropsychological function.
Summary
If a Chiropractor provides service to one to two regions, it is appropriate to bill with CPT code 98940. In contrast, CPT 98941, 98942, and CPT 98943 bill for spinal treatment up to 4 and 5 regions.
The chiropractor performs service to treat the extra-spinal region (head, extremities, rib cage, and abdomen), one or more areas, report CPT 98943.
These manipulative treatments are effective for low back pain, cervicalgia, and thoracic pain and aid in lowering the headache and other abnormal conditions of the spine region.
Chiropractors use two types of techniques for spinal manipulation treatments. One is spinal manipulation, and the other is Spinal Mobilization. The chiropractor performs the spinal manipulation with full force, resulting in a sound such as “POP.”
When chiropractors apply less pressure to manipulate the regions, known as spinal mobilization, it typically performs for osteoporosis, preference of the patient, comfort due to size and condition do not require forceful thrust.
The chiropractor performs other therapies like (ice, heat, or physical) in addition to spinal mobilization and spinal manipulation.
Electric stimulation, ultrasound, etc., consider physical therapies.
Chiropractors frequently perform spinal manipulations. But also, osteopathic physicians and physical therapists can provide such services.
Code Description
CPT code 98941 will be reported by the physician when Chiropractic manipulative treatment (CMT) performs at the spinal up to 3-4 regions.
The official description of CPT 98941 is: “Chiropractic manipulative treatment (CMT); spinal, 3-4 regions.”
Reimbursement
A maximum of one unit of CPT 98941 is allowed to bill on the same day.
In contrast, a maximum of Two times are allowed when documentation supports the medical necessity of CPT code 98941.
The CPT 98941 cost and RUVS are as follows when performed in the facility; it will be $36.99 and 1.06890, respectively.
In contrast, non-facility will be $43.90 and 1.26865, respectively.
Billing Guidelines
Documentation must support the medical necessity of service. It reflects that Chiropractic manipulation treatment is medically necessary and appropriate.
The most used ICD codes are as follows:
M99.00, M99.01, M99.02, M99.03, M99.04, and M99.05. The subluxation (partial dislocation within the body) is the primary diagnosis code.
The services accept manipulation of the spine for treatment excluded by Medicare when performed by a Doctor of Chiropractic.
Medicare does not pay for drugs, X-rays, office visits, drugs, supplies, injections, traction, or orthopedic services.
This includes diagnostic studies such as EKGs, laboratory tests, nutritional supplements, and counseling.
Chiropractic charts should comprise the date when treatment begins, condition, DOS, and POS; Insurance denies this claim except for this information, symptoms, subluxation, procedure code, and primary and secondary diagnosis code.
CPT code 98941 includes five extraspinal regions and five spinal regions.
The five extraspinal regions are the upper extremities, head, temporomandibular joint, excluding atlantooccipital region, rib cage, not including costotransverse/costovertebral joints, abdomen, and lower extremities.
Spinal regions consist of the pelvic region (sacroiliac joint), cervical region (atlantooccipital joint), sacral region, lumbar region, and thoracic region (costovertebral/costotransverse joints).
Manual treatment performed to influence joint/neurophysical function is also included in CPT code 98941, do not report separately.
If any evaluation and management (E/M) service perform in conjunction with CPT code 98941, it is appropriate to report with modifier 25.
Billing Examples
You can read about cases when the 98941 CPT code is billed appropriately here.
Example 1
A 39-year-old male with tumors on the lumbar region presented to the emergency department with c/o constant low back pain that started two days ago.
The patient was unable to walk for 1-week. The patient is consulted with his primary care physician and suggested to go emergency department.
He denies trauma, heavy palpitations, dizziness, cough, recent illness, fever, chills, back pain, abdominal pain, nausea, recent travel, known sick contacts, antibiotic use, near-syncope or syncope, changes in stool color, urinary complaints, or any other symptoms.
The patient took his routine medication. The physician ordered a CT scan of the lumbar region.
The physician plans to do a surgical procedure to excise the tumor.
Example 2
A 76-year-old male presents to the office for radiculopathy and stenosis of the lumbar region.
He has had severe low back pain since last week. The patient took some medication for pain, but it is getting worse daily.
Denies trauma, heavy palpitations, dizziness, cough, recent illness, fever, chills, back pain, abdominal pain, nausea, recent travel, known sick contacts, antibiotic use, near-syncope or syncope, changes in stool color, urinary complaints, or any other symptoms.
CT scans of the lumbar region reveal spondylosis of the L2-L3 level, disc protrusion at the L4-L5 level, and degenerated changes at the L5-S1 area.
The physician ordered a steroid injection in the epidural space at L4-L5 level and got relief from the pain.
The physician prescribed pain medicines and referred him for chiropractic treatment.
Example 3
A 39-year-old male presents to the office with PMH of thyroid cancer presented to the emergency department with c/o constant neck pain that started four days ago and was unable to eat anything for 1-week.
The patient consulted with his primary care physician, who suggested to go to ED.
The patient denies trauma, heavy palpitations, dizziness, cough, recent illness, fever, chills, back pain, abdominal pain, nausea, recent travel, known sick contacts, antibiotic use, near-syncope or syncope, changes in stool color, urinary complaints, or any other symptoms, and took his routine medication.
The physician ordered a CT scan of the soft tissues of the neck.
The study revealed that multiple thyroid nodules and biopsies were sent to labs to check if the lesion or malignant.
The physician refers him to the chiropractor for pain management of the neck region.
Example 4
A 70-year-old female presented to the office with cervicalgia for one week.
The pain gets worse with movement and when lying down. The patient took some medication for pain.
The patient denies other symptoms such as headache, numbness, urinary problems, nausea, vomiting, and shortness of breath.
The physical exam revealed swelling in the neck region.
The physician ordered a CT of the cervical spine. It shows the cervical spine’s degeneration at C1 – C2, C3 – C4, and disk budging at the C4-C5 level.
The patient also has spondylosis of the cervical spine.
The physician prescribed medicine for pain and treatment and suggested chiropractic treatment.
Example 5
A 60-year-old female presents to the office with low back pain for three to four days.
The pain gets worse with movement and when lying down. The patient took some medication for pain.
The patient denies other symptoms, such as headache, numbness, urinary problems, nausea, vomiting, and shortness of breath.
A physical exam revealed swelling in the Lumbar region. The physician ordered a CT Lumbar spine. It shows degeneration of the lumbar spine at L1 – L4, L5– S1, and disk budging at the L5-L6 level.
The patient also has spondylosis of the Lumbar Spine.
The physician has administrated steroid injections via transformational epidural space for pain management.
The physician refers a chiropractor for pain management.
