Chiropractic CPT codes are managed and maintained by the American Medical Association (AMA), and categorize every evaluation, diagnostic test, medical procedure or treatment performed by chiropractors. These codes cover everything from checkups and exams to treatments provided.
Understanding CPT Codes and Categories in Chiropractic Care:
CPT codes consist of five characters which may consist of either letters or numbers and serve as an international language to share details regarding medical procedures with insurance providers and healthcare providers. Knowing CPT codes well is integral for chiropractors managing their practices effectively.
Categories of Chiropractic CPT Codes:
CPT codes fall under three main categories; chiropractors tend to utilize Category 1. These CPT codes describe procedures done both hospital and clinic settings and here are some typical Category 1 codes used by chiropractors.
| Category | CPT Code | Description | Medicare Fee 2024 |
| Evaluation and Management | 99203 | Initial Examination | $111.51 |
| Chiropractic Manipulative Treatment | 98940 | Chiropractic manipulative treatment (CMT); spinal, 1-2 regions | $27.30 |
| Physical Therapy and Rehabilitation | 97110 | Therapeutic Exercise | $29.29 |
Importance of Modifiers in Chiropractic Billing
Failing to properly utilize these modifiers or using them incorrectly could cause insurance claims for chiropractic services to be rejected, including:
| Modifier | Description |
| Modifier 25 | This modifier is used to indicate that a significant, separately identifiable evaluation and management service was performed by the same physician on the same day as another procedure or service. It’s crucial for claiming additional services that are not normally reported together. |
| Modifier 59 | Modifier 59 is utilized to denote that a particular procedure or service was distinct and independent from other services performed on the same day. This modifier helps to prevent bundling and ensure proper reimbursement for procedures that are not typically performed together. |
Chiropractic CPT Codes:
Chiropractors use specific CPT codes pertaining to manipulative therapies. Here is the primary list for spinal manipulation treatments by region of spine:
| CPT Code |
Description |
Medicare Fee 2024 |
| 98940 | Treatment for 1-2 spinal regions | $27.30 |
| 98941 | Treatment for 3-4 spinal regions | $39.28 |
| 98942 | Treatment for 5 spinal regions | $50.60 |
| 98943 | Treatment for extraspinal regions | $25.63 |
Documentation Best Practices:
Keep accurate records. For instance, when applying the CPT code 98941, make sure your records clearly demonstrate that 3 to 4 areas were treated and documented accordingly; failing this may cause claims to get rejected – an underscoring the significance of careful documentation!
Here’s the list of chiropractic CPT (Current Procedural Terminology) codes:
| CPT Code |
Description |
Medicare Fee |
Evaluation and Management CPT Codes |
||
| 99202 | Evaluation and Management, Initial Visit | $72.23 |
| 99203 | Evaluation and Management, Initial Visit | $111.51 |
| 99204 | Evaluation and Management, Initial Visit | $167.10 |
| 99211 | Re-evaluation | $23.30 |
| 99212 | Evaluation and Management, Established Patient | $56.59 |
| 99213 | Evaluation and Management, Established Patient | $90.87 |
| 99214 | Evaluation and Management, Established Patient | $128.16 |
Physical Therapy and Rehabilitation CPT Codes |
||
| 97110 | Therapeutic Exercise | $29.29 |
| 97112 | Neuromuscular Re-education | $33.62 |
| 97116 | Gait Training | $29.29 |
| 97124 | Massage | $30.29 |
| 97140 | Manual Therapy | $26.96 |
| 97161 | PT Evaluation: Low Complexity | $100.20 |
| 97162 | PT Evaluation: Moderate Complexity | $100.20 |
| 97113 | Aquatic Exercise | $36.62 |
| 97530 | Therapeutic Activities | $36.62 |
| 97535 | Self-Care/Home Management Training | $36.62 |
Physical Modalities CPT Codes |
||
| 97010 | Hot/Cold Packs | $6.32 |
| 97012 | Mechanical Traction | $13.98 |
| 97014 | Electrical Stimulation (Unattended) | $12.32 |
| 97018 | Paraffin Bath | $5.66 |
| 97022 | Whirlpool | $16.98 |
| 97026 | Infrared Light | $6.66 |
| 97032 | Electrical Stimulation (Manual) | $14.31 |
| 97033 | Iontophoresis | $19.31 |
| 97035 | Ultrasound/Phonophoresis | $13.98 |
| 97039 | Laser/Other | $14.31 |
Physical Performance and Testing CPT Codes |
||
| 97750 | Physical Performance Examination | $33.95 |
Radiologic Examinations CPT Codes |
||
| 72020 | Radiologic examination, spine, single view, specify level | $24.30 |
| 72040 | Radiologic examination, spine, cervical; two or three views | $39.61 |
| 72070 | Radiologic examination, spine; thoracic, two views | $32.95 |
| 72072 | Radiologic examination, spine; thoracic, three views | $39.61 |
| 72100 | Radiologic examination, spine, lumbosacral; two or three views | $39.95 |
| 72170 | Radiologic examination, pelvis; one or two views | $27.96 |
| 72190 | Radiologic examination, pelvis; complete, minimum of three views | $42.28 |
| 72200 | Radiologic examination, sacroiliac joints; less than three views | $33.29 |
| 72220 | Radiologic examination, sacrum and coccyx; minimum of two views | $32.62 |
Frequently Asked Questions (FAQ):
What CPT codes can chiropractors use?
Chiropractors often utilize CPT codes specific to chiropractic services such as 98940 (chiropractic manipulative treatment for spinal regions 1-3) and 98941 (3-4 regions).
What are chiropractic modifiers?
Chiropractic modifiers are codes added to CPT codes in order to add extra details about treatment given, indicate special circumstances or clarify nature of services performed, ensuring accurate billing and reimbursement of services performed. Common chiropractic modifiers include:
- AT (Active Treatment): Indicates the service is part of active treatment for a specific condition.
- 25 (Significant, Separate Service): Used when a significant, separate evaluation is performed on the same day as another service.
- 59 (Distinct Procedural Service): Shows that a service is distinct or separate from others provided on the same day.
- 51 (Multiple Procedures): Applied when multiple procedures are done in a single visit.
- 52 (Reduced Services): Used when a service is reduced or not fully performed.
- X-(EPSU} (Specific Circumstances): Modifiers (XE, XP, XS, XU) that provide extra clarity on the nature of the services provided, especially for Medicare billing.
What is the CPT code 99213 for chiropractors?
CPT code 99213 describes an office or other outpatient visit for the evaluation and management of established patients that involves at least two of three components outlined below – detailed history gathering, detailed examination procedures and low complexity medical decision-making activities (i.e.: including physical exams). Activities can include:
- Review of medical history components that encompass multiple aspects.
- Comprehensive physical exam including multiple body systems being assessed.
- Medical decision-making of low complexity such as minor surgical option
What is CPT code 97530 for chiropractic?
CPT Code 97530 covers therapeutic activities conducted directly between provider and patient (use of dynamic activities to increase functional performance), usually for 15-minute increments. Activities covered under this CPT code typically include:
- Exercising to improve strength and endurance, range of motion and flexibility are some exercises designed to develop strength.
- Dynamic activities targeting functional improvement in daily living tasks.
- Sessions typically last 15 minutes each.
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