Chiropractor

Chiropractic cares for a patient’s neuromusculoskeletal system, which includes the bones, nerves, muscles, tendons, and ligaments. A chiropractor uses spinal adjustments to maintain adequate alignment to help manage back and neck pain.

The only services that count toward the deductible for chiropractic claims are spinal manipulation (98940, 98941, and 98942).

Manual manipulation for the treatment of a subluxation is the only thing covered. Chiropractors use the term “subluxation” to describe a vertebra in the spine that is out of alignment with the others.

PART (Pain, Asymmetry, Range of motion, and tissue tone changes)

•  Pain – Most primary neuromusculoskeletal disorders manifest primarily by a painful response
•  Asymmetry/misalignment – Asymmetry/misalignment may be identified on a sectional or segmental level through one or more of the following: observation (posture and gait analysis), static palpation for the misalignment of vertebral segments, diagnostic imaging, etc.
•  Range of motion abnormality – Range of motion abnormalities may be identified through one or more of the following: motion, palpation, observation, stress diagnostic imaging, range of motion measurements, etc.
•  Tissue/Tone texture may be identified through one or more of the following procedures: observation, palpation, use of instruments, tests for length and strength, etc

Coding Guidelines

1. The precise level of the subluxation must be specified on the claim and must be listed as the primary diagnosis. The neuromusculoskeletal condition necessitating the treatment must be listed as the secondary diagnosis.
2. All claims for chiropractic services must include the following information:
   Date of the initiation of the course of treatment.
   Symptom/condition/Secondary diagnosis code(s)
   Subluxation(s)/Primary diagnosis code(s)
   Date of Service
   Place of Service
   Procedure Code
   Failure to report these items will result in claim denial or delay
3. Non-Covered Services:
   All services other than manual manipulation of the spine for treatment of subluxation of the spine are excluded when ordered or performed by a Doctor of Chiropractic. Chiropractors are not required to bill these to Medicare. Chiropractic offices may want to submit charges to Medicare to obtain a denial necessary for submitting to a secondary insurance carrier. The following are examples (not an all-inclusive list) of services that, when performed by a Chiropractor, are excluded from Medicare coverage:
   – Laboratory tests
   – X-rays
   – Office Visits (history and physical)
   – Physiotherapy
   – Traction
   – Supplies
   – Injections
   – Drugs
   – Diagnostic studies including EKGs
   – Orthopedic devices
   – Nutritional supplements and counseling
4. Medicare does not cover chiropractic treatments to extraspinal regions (CPT 98943), which includes the head, upper and lower extremities, rib cage, and abdomen.

Claims submitted for Chiropractic Manipulative Treatment (CMT) CPT codes 98940, 98941, or 98942, (found in Group 1 codes under CPT/HCPCS Codes) must contain an AT modifier or they will be considered not medically necessary.

Group 1 CPT codes

Group 2 CPT code

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