CPT code 98941

(2022) CPT Code 98941 – Description, Guidelines, Reimbursement, Modifiers & Examples

CPT code 98941 bills for service when Chiropractic services perform 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

Suppose 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, thoracic pain, and aid to lower the headache and other abnormal conditions of 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 and results in the form of 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. 

CPT Code 98941 Description

CPT code 98941 will be reported by the physician when Chiropractic manipulative treatment (CMT) performs at the spinal up to 3-4 regions.

98941 cpt code
CPT 98941 chiropractic description.

CPT Code 98941 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.

Modifiers

The following list of modifiers that are applicable with CPT 99283

  • 22, 23, 47, 52, 53, 58, 59, 76, 77, 78, 79, 99, AI, AQ, AR, AT, CC, CR, ET, EY, GA, GC, GJ, GK, GR, GU, FY, GZ, KX, Q5, Q6, QJ, XE, XP, XS, and XU. 

If chiropractors believe that Medicare will deny such service, it is appropriate to report with AT modifier.

The beneficiary must sign an Advance Beneficiary Notification (ABN), and the GA modifier must be applying to that service. 

Modifier 23 is applicable with CPT code 98941 when general or local anesthesia administers by the physician and routinely does not require during the procedure. 

Modifier 76 will be attached to CPT code 98941 if service repeats by the same physician on the same day.

In contrast, modifier 77 is appropriate when a procedure repeats on the same date service by a different physician. 

Modifier 78 will be appended with CPT code 98941 if the procedure repeats for an identical condition in the global period.

For instance, the patient had surgery on L1 vertebrae and saw by a chiropractor for surgery-related issues. 

In contrast, modifier 79 is applicable when the service reports for an unrelated condition.

For example, a patient was seen by the physician in the post-operative period for cervicalgia instead of L1 surgery-related issues.  

Modifier 59 is applicable with CPT code 98941 if any other procedure performs in combination with these services.

They do not typically play together on the same date of service.

Moreover, modifier 59 will be appropriate, or service performs on the distinct region on the same day. 

Modifier 53 will be reported with CPT code 98941 if unsuccessful administration of an anesthetic agent to the lumbar or sacral region due to unavoidable circumstances like allergic reactions to the substance.

Modifier 52 applies when the physician does not complete the chiropractic treatment and service is terminated due to unavoidable circumstances. 

cpt 98941
CPT 98941 chiropractic modifiers.

CPT Code 98941 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) reports as 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 services such as drugs, X-rays, office visits, drugs, supplies, injections, traction, orthopedic services.

This also includes diagnostic studies such as EKGs, laboratory tests, nutritional supplements, and counseling. 

Chiropractic charts should comprise the date when treatment begins, condition, DOS, POS, Insurance deny this claim except for this information, symptoms, subluxation, procedure code, 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.  

CPT Code 98941 Examples

The following are examples of CPT 98941 when service bills:

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 is getting worse day by day.

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 L2-L3 level, disc protrusion at L4-L5 level, and degenerated changes at the L5-S1 area.

The physician ordered 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 is consulted with his primary care physician and suggested to go 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 any other symptoms such as headache, numbness, urinary problems, nausea, vomiting, 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 any other symptoms such as headache, numbness, urinary problems, nausea, vomiting, shortness of breath.

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 injection via transformational epidural space for pain management.

The physician refers a chiropractor for pain management.

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