2025 CPT code 98940
(Active) Effective Date: N/A Revision Date: N/A Chiropractic - Chiropractic Manipulative Treatment Procedures Medicine Services and Procedures Feed
Chiropractic manipulative treatment (CMT) of the spine involving one to two regions.
Modifiers may be applied depending on the circumstances of service.Consult the current CPT codebook and payer-specific guidelines for appropriate modifier usage.
Medical necessity for 98940 is established by documenting a musculoskeletal condition requiring chiropractic manipulation.This would typically involve symptoms such as pain, stiffness, or restricted range of motion in the spine, supported by the patient history and physical examination findings. The treatment must be deemed reasonable and necessary by the payer.
The chiropractor is responsible for conducting a thorough examination, including reviewing patient history, performing a physical examination, and potentially ordering imaging studies (such as X-rays). Based on the assessment, a treatment plan is developed and implemented, involving manual manipulation of the specified spinal regions.Post-treatment assessment of the patient's response is also part of the clinical responsibility.
In simple words: This code describes a chiropractor's hands-on treatment to improve the movement and function of one or two areas of the spine.The chiropractor will assess your spine before treatment and might use different techniques to adjust it.
This CPT code, 98940, represents chiropractic manipulative treatment (CMT) targeting one to two spinal regions.The procedure includes a pre-manipulation assessment and the application of manipulative techniques to influence joint and neurophysiological function.Multiple techniques and modalities may be used. Spinal regions include cervical (including the atlanto-occipital joint), thoracic (including costovertebral and costotransverse joints), lumbar, sacral, and pelvic (sacroiliac joint) regions.Additional evaluation and management (E/M) services may be billed separately with modifier 25 if a significant, separately identifiable E/M service is performed beyond the usual pre- and post-service work associated with the CMT.
Example 1: A patient presents with acute low back pain and restricted range of motion in the lumbar spine.The chiropractor performs CMT on the lumbar and sacral regions., A patient with chronic neck pain and headaches reports limited cervical rotation.The chiropractor performs CMT on the cervical and thoracic regions., An athlete experiences sudden onset of pain in the thoracic spine after a sports injury. The chiropractor conducts a thorough examination, and following diagnosis and obtaining consent from the patient, performs CMT on the thoracic spine.
* Detailed patient history documenting the chief complaint, onset of symptoms, and relevant past medical history.* Thorough physical examination findings including range of motion, palpation findings, and neurological assessment (if indicated).* Documentation of the specific spinal regions treated.* Description of the techniques used.* Documentation of patient response to treatment and plan for ongoing care.* Imaging reports (if any).
** Accurate documentation is critical for reimbursement.Always consult payer-specific guidelines and local coverage determinations (LCDs).
- Revenue Code: O1B
- RVU: Refer to the CMS Physician Fee Schedule for the most current RVU values and reimbursement rates. RVUs vary by location and payment model.
- Global Days: The global period for chiropractic manipulation is typically not defined in the same way as surgical procedures; each visit is typically separately billable.
- Payment Status: Active
- Modifier TC rule: Not applicable to this code.
- Fee Schedule: Fee schedules vary by payer and location.Historical fee data can be accessed through various commercial databases.Consult the CMS Physician Fee Schedule for Medicare fee information.
- Specialties:Chiropractic
- Place of Service:Office, Chiropractic Clinic