Chiropractic Services (CPT Codes 98940-98942): Coverage and Documentation Requirements


This Comparative Billing Report (CBR) focuses on physicians who submit claims for Chiropractic Services (CPT codes 98940 – 98942). CBR information is one of the many tools used to assist individual providers to become proactive in addressing potential billing issues and performing internal audits to ensure compliance with Medicare guidelines.

For your personalized Chiropractic Services (CPT codes 98940 – 98942) eCBR results log on to eServices.

Chiropractic Services (CPT Codes 98940-98942):  Overview of Coverage Requirements
Coverage of chiropractic services is specifically limited to treatment by means of manual manipulation (i.e., by use of the hands) of the spine to correct a subluxation. Subluxation is defined as a motion segment in which alignment, movement integrity, and/or physiological function of the spine are altered, although contact between joint surfaces remains intact.

Manual devices (i.e., those that are hand-held with the thrust of the force of the device being controlled manually) may be used by chiropractors in performing manual manipulation of the spine. No additional payment is available for use of the device, nor does Medicare recognize an extra charge for the device itself.

No other diagnostic or therapeutic service furnished by a chiropractor or under the chiropractor’s order is covered.

Chiropractic Services (CPT Codes 98940-98942):  Documentation Requirements

CPT Code
Area/Region(s) Treated
Number of Regions
Documentation Requirements
98940
Spinal (cervical region, (includes atlanto-occipital joint); thoracic region (includes costovertebral and costotransverse joints); lumbar region; sacral region; and pelvic (sacro-iliac joint) region) 
One or two
  • Pre manipulation assessment (review of imaging, physical examination documentation)
  • Response/Outcomes  to Treatment
  • Plan for Ongoing Care
98941
Spinal (cervical region, (includes atlanto-occipital joint); thoracic region (includes costovertebral and costotransverse joints); lumbar region; sacral region; and pelvic (sacro-iliac joint) region) 
Three to four
  • Pre manipulation assessment (review of imaging, physical examination documentation)
  • Response/Outcomes  to Treatment
  • Plan for Ongoing Care
98942
Spinal (cervical region, (includes atlanto-occipital joint); thoracic region (includes costovertebral and costotransverse joints); lumbar region; sacral region; and pelvic (sacro-iliac joint) region) 
Five
  • Pre manipulation assessment (review of imaging, physical examination documentation)
  • Response/Outcomes  to Treatment
  • Plan for Ongoing Care

Education Resources
The Provider Outreach and Education (POE) team has published a Web-Based Training (WBT) module to address the issues pertinent to Medicare chiropractic billing and coverage. Your practice is being advised to view the
Chiropractic Basic Billing Module.

Methods
The metrics reviewed in this CBR are the proportion of billing for each HCPCS code in the grouping with comparisons done to peers with the same specialty in the state and the jurisdiction. This report is an analysis of Medicare Part B claims extracted from the Palmetto GBA data warehouse. For the purpose of this CBR, 'peer group' is defined as other providers in Jurisdiction M (JM) who have the same specialty. The analysis shows the portions of your Chiropractic Manipulative Treatment family of codes (CPT codes 98940-98942) claims at each level compared to your peers in JM.

Example of eCBR Results from eServices

Example of eCBR Results from eServices

Please be aware that the information contained within this CBR is not intended to be punitive or an indication of fraud. Rather, it is intended to be proactive communication that will assist you in identifying potential billing issues and help you with performing a self-audit of your conformity with Medicare guidelines.





Last Updated: 02/07/2018