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Chiropractic CPT Codes to Improve Your Insurance Reimbursements

chiropractic cpt codes

Chiropractic CPT codes are some of the most important components of the insurance billing process. Accurate chiropractic insurance billing is essential for your practice’s revenue cycle management, but errors can cause costly denials and delays.

As a billing company focused on holistic healthcare providers, Holistic Billing has the answers to many of the most common questions about chiropractic insurance billing and CPT codes. Find the answers below!

How Do You Bill for Chiropractic Treatments?

chiropractic cpt codes

Chiropractic practices must bill insurance companies to receive insurance reimbursements using specific chiropractic CPT codes. These special CPT codes characterize the type of procedure being done so healthcare providers - whether conventional or holistic - can bill insurance companies for the right services and receive their due payment for treatments

Holistic practices have their unique requirements when it comes to receiving insurance reimbursements. For a streamlined insurance billing process, practices must use accurate CPT codes that are unique to their specialty and procedures. Chiropractic CPT codes are some of the most important code sets for chiropractors. 

What are Chiropractic CPT Codes?

Current Procedural Terminology codes, or CPT codes, are used by insurance providers to describe most medical procedures performed by healthcare providers across all specialties. Each of these CPT codes contains five alpha-numeric characters to document evaluations, diagnostic tests, and other procedures performed on patients. 

Chiropractic CPT codes document the various procedures, diagnoses, and evaluations that involve chiropractic treatments. Since these CPT codes enable healthcare providers to bill insurance companies for their treatments and services, accurate insurance billing is important to receive payments on time. 

Four Essential Chiropractic CPT Codes

While there are numerous chiropractic CPT codes, there are four main CPT codes chiropractors use. Each code represents a specific region of the spine that was treated. These main codes are as follows:

98940 Chiropractic Manipulative Treatment (CMT)

Used for the examination, diagnosis, and manipulative treatment of one to two spinal regions. 

98941 Chiropractic Manipulative Treatment (CMT)

Used for the examination, diagnosis, and manipulative treatment involving between three and four spinal regions. 

98942 Chiropractic Manipulative Treatment (CMT)

Used for the examination, diagnosis, and manipulative treatment involving five or more spinal regions.

98943 Chiropractic Manipulative Treatment (CMT)

Used to report chiropractic manipulation of one or more of the extra-spinal regions.

There are additional two chiropractor modifier codes commonly used. These can be attached to certain CPT codes to tell insurance providers that some of the treatments the CPT code describes were slightly altered. If your selected chiropractic CPT code requires a modifier but you fail to include it, your claim will be denied by the insurance company. These codes are as follows:

Modifier 25

This Modifier is used to report a significant and separately identifiable Evaluation and Management (E/M) service on a day when another service was provided to the patient by the same physician or other qualified healthcare professional.

Modifier 59

Use this Modifier to report a procedure or service that was distinct or independent from other non-E/M services performed on the same day.

Four CPT Coding Tips for to Improve Your Insurance Reimbursements

cpt codes for chiropractic practice

Follow these best practice tips for an efficient and disruption-free insurance reimbursement process!

Keep Organized Patient Records

Keeping accurate, up-to-date information about your patient’s records will help ensure a smooth insurance billing process - as well as help you provide the most effective chiropractic treatments for patients. This includes having well-documented patient charts and paperwork. 

Besides having easy access to crucial patient information, organized patent records will be important when facing a medical billing audit. 

Verify Your Patient’s Insurance Eligibility

Just because your established patients have been with your practice for years doesn’t mean their insurance records don’t need to be updated every now and then. Many holistic practices - including chiropractors - run into problems with insurance companies when claims are rejected due to ineligible insurance coverage of established patients. Whether or not the patient declined to alert their healthcare provider about the insurance change or if the provider failed to update patient records, outdated insurance can result in delayed payments. 

Stay Up To Date With New Codes or Code Changes

Chiropractic CPT codes can be modified and revised throughout the years. Your chiropractic practice needs to stay updated about any changes so you’re not billing with any outdated codes that could cause issues with insurance companies. 

Analyze Denied Insurance Claims

If you do have any claims that are denied, make sure to analyze them to understand what went wrong. Analyzing claims can find patterns that can be corrected to prevent further loss of revenue. 

Improve Revenue Cycle Management in Your Holistic Practice With HBS!

Reducing your practice’s denials and delays is essential for building your revenue cycle management. However, ensuring your insurance billing is as accurate as possible while growing your holistic practice can be difficult. That’s why outsourcing your chiropractic insurance billing can help!

As an experienced billing provider for holistic practices, Holistic Billing Services can handle all your insurance billing details to minimize denials while you can focus on delivering the best treatment to your patients.  Want to learn more? Talk to one of our billing and coding experts today.

March 9, 2021
 - by Antonio Arias, MBA, CHBME
chiropractic cpt codes
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