Are you aware that more than 35 million Americans see a chiropractor yearly for help with pain and to help them obtain more vitality in their lives? Chiropractic manipulative treatment (CMT) is essential for dealing with conditions relating to spinal health, and there’s a number on most practices’ lips when billing comes up—CPT code 98941. If you are a healthcare provider or an administrator within a healthcare organization, then learning to navigate this code can make reimbursement easy and improve patient outcomes.
In this blog, we’ll dissect everything you need to know about CPT code 98941, its use case, and how proper documentation leads to compliance and profitability.
What Is CPT Code 98941?
At its base, CPT 98941 describes CMT of the spine involving 3–4 areas (CMT) but then delves deeper than the traditional chiropractic adjustment. This code, in particular, is vital when billing for services rendered by a chiropractor when treating pain syndromes in multiple regions of the spine, such as:
- Cervical (neck),
- Thoracic (mid-back),
- Lumbar (lower back),
- Sacral, and
- Pelvic regions
This code is specifically intended to report the complexity of treatment involved with spinal care to Medicare as well as private carriers. Proper billing of CPT 98941 allows a chiropractor to be reimbursed correctly, and the financials comply with Medicare chiropractic fee schedule guidelines.
What is Included in a Procedure for CPT Code 98941?
When you’re a chiropractor billing CPT code 98941, not all of those bones you crack are pretty much the same. Chiropractic manipulative therapy is a type of manual therapy that uses precise, high-velocity adjustments to restore lost movement in spinal segments. The following is what usually occurs during these sessions:
Manual manipulation with hands or an activator tool to correct the position.
Mobilization is a number of techniques used to increase flexibility and alleviate stiffness.
Pressure is applied to some regions of the spine to relieve pressure on compressed nerves.
These therapies are widely used for everyday complaints such as lumbar pain, neck pain, and even sciatica and provide tremendous clinical outcomes in terms of relief and the return of function to the spine.
Common Diagnoses When You Can Bill for CPT Code 98941
Lower Back Pain
In cases of acute lumbar pain resulting from bad posture, injury, or long periods of sitting or lying down, chiropractic is highly effective. CMT is under CPT 98941 and can help reduce inflammation, alleviate pain, and improve the mobility of the lumbar spine.
Neck Pain
From work-related ergonomic problems to injuries due to accidents – CPT 98941 is perfect for neck pain. Neck manipulation through chiropractic can help restore range of motion and alleviate headaches and muscle tightness.
Sciatica
For individuals challenged by the piercing pain of sciatica, Chiropractic care focuses on spinal misalignment relief, which relieves the pressure from the sciatic nerve. This has been pretty successful in increasing patient comfort.
Medicare and Chiropractic Services
The fee schedule will vary from area to area, and it does pay for you to check and see if you’re billable for CPT code 98941. Active condition: Medicare only pays for the manipulation to correct a subluxation when the chiropractor has been able to document the medical necessity of care.
Key Points for Billing:
Documentation Requirements:
Patient’s history and physical examination.
Diagnosis: Chiropractic care is indicated.
Areas targeted ( e.g., lumbar, sacral).
Treatment plan and evidence for improvement.
Avoid Common Pitfalls:
Incorrectly coded regions.
No supporting documents were provided.
Failure to have a Medicare compliance program could result in claim denials or delays. However, follow these easy-to-understand steps and it’s smooth sailing for reimbursement of that CPT for chiropractic manipulation.
You Have to Be Cautious With Coding and Documenting
Whether you are billing CPT code 98941 to Medicare or private payers, proper coding and detailed documentation are crucial. A great way to ease the process is to create a checklist.
- Precise Coding:
Differentiate similar code pairs, such as CPT 98940 (1–2 spinal regions) and 98942 (5 or more regions).
- Detailed Records:
Document all patient visits, encounters, and follow-ups in the EHR.
- Reduce Errors:
Coding errors in the complex process of billing can lead to underpayment or denials. Hire professionals for staff training, or outsource the work to a billing specialist like Providers Care Billing, LLC.
Real-Life Success Story of Chiropractic Care
This is Sarah, a feisty 42-year-old office administrator who entered a clinic because of neck and sciatic pain. Her chiropractor focused on her cervical, thoracic, and lumbar spine with CPT code 98941. Following a few more adjustments and exercises to strengthen the affected muscles, Sarah noticed a 35% decrease in pain after 4 appointments. She was able to walk short distances and gained a significant quality of life over 8 weeks of therapy. Sarah’s success story emphasizes the critical need for accurate billing for successful patient outcomes.
If the patient presents symptoms like chronic headaches, dizziness, or altered mental status, providers may need to order advanced imaging studies. In such cases, an MRI of the brain with and without contrast (CPT Code 70553) is commonly used to assess deeper neurological concerns.
Frequently Asked Questions
98940, 98941, 98942: What’s the Difference?
98940 applies to 1–2 spinal regions.
98941 is 3–4 regions in the spine.
covers 5 or more regions (98942-98943) of the spine
What is the frequency with which I can report 98941 to Medicare?
The frequency is determined by the need for the treatment and by the progress of the patient. Make sure documentation always backs up every visit.
What are the guidelines for CPT code 98941?
Indicate patient history, physical examinations, procedures performed, specific therapy (including drugs and dosages), and the medical rationale for continued care.
Increase Reimbursement with Specialists in Billing
Chiropractic treatment is changing lives, mainly under the CPT code 98941, which is billed for the care. But the weeds of coding and compliance can be treacherous to get lost in. Providers Care Billing LLC is here to help; We are an Illinois-based, state-of-the-art service provider to medical professionals with a leading rate of only 2.89%. You don’t have to manage this process alone. With 100% client satisfaction and a phenomenal 4.9-star rating, we strive to make this process as effortless for you as possible.
Contact us today for a free consultation and find out how we can improve your billing process and allow you the freedom to concentrate on caring for your patients.
