Chiropractic Coding & Compliance Alert

Question: The provider performs CMT to the left shoulder. He also performs CMT of the lumbar region. How does he bill for both the services to Medicare? 

Illinois Subscriber

Answer: Medicare pays chiropractors for spinal manipulation CPT® codes 98940–98942, when these services are reasonably and medically necessary and meet all Medicare coverage guidelines as set forth in the Centers for Medicare and Medicaid Services (CMS) Internet-Only Manuals (IOM). The descriptors are as follows:

• 98940 -- Chiropractic manipulative treatment (CMT); spinal, 1-2 regions

• 98941 -- … spinal, 3-4 regions

• 98942 -- … spinal 5 regions

• 98943 -- … extraspinal, 1 or more regions.

Note: CPT® code 98943 (CMT, extraspinal, one or more regions) is not a Medicare benefit.

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