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2025 CPT code 98941

Chiropractic manipulative treatment (CMT); spinal, 3-4 regions

Refer to the AMA CPT manual and payer-specific guidelines for detailed coding instructions and restrictions.

Modifiers 25 (significant, separately identifiable E/M service), AT (acute treatment), and potentially others may be applicable depending on the circumstances.

Medical necessity for CMT is established when the patient presents with musculoskeletal complaints such as pain, limited range of motion, or dysfunction in the spine. Documentation must support the diagnosis and demonstrate the need for CMT to improve function and alleviate symptoms.Specific payer requirements and guidelines should be considered.

The chiropractor performs a detailed history, examination, and may use imaging (x-rays) to assess the patient's condition.Based on the assessment, they decide on the treatment plan which may involve multiple visits. Treatment includes manual manipulation techniques applied to specific spinal regions.

IMPORTANT:For one to two spinal regions, use 98940. For five spinal regions, use 98942.For extraspinal regions, use 98943.

In simple words: The chiropractor adjusts three to four areas of the spine to improve alignment and reduce pain. This involves a hands-on approach to correct misalignments and improve how the spine functions.

This CPT code reports chiropractic manipulative treatment (CMT) performed on three to four spinal regions.The treatment involves manual manipulation techniques to correct subluxations and improve spinal alignment and function.A pre-manipulation patient assessment is included.Additional evaluation and management (E/M) services may be reported separately using modifier 25 if clinically significant.

Example 1: A patient presents with neck pain radiating into the right arm, limited cervical range of motion, and tenderness to palpation in the upper thoracic spine. The chiropractor performs CMT to the cervical, upper thoracic, and mid-thoracic regions (3 regions)., A patient experiences lower back pain with muscle spasms in the lumbar and sacral regions. The chiropractor assesses the patient, and performs CMT to the lumbar, sacral, and pelvic regions (3 regions), improving range of motion and reducing muscle spasm., A patient with chronic neck and upper back pain presents for care. After a thorough exam, the chiropractor performs CMT to the cervical, thoracic, and lumbar regions (3 regions), with a plan for follow-up treatment.

* Detailed patient history including chief complaint, onset of symptoms, and relevant past medical history.* Physical examination findings noting range of motion, palpation findings, and any neurological symptoms.* Documentation of imaging studies (if performed), such as X-rays.* Specific spinal regions treated (3-4).* Treatment plan and rationale for chosen treatment approach.* Patient response to treatment.* Plan for ongoing care.

** Accurate documentation is crucial for proper reimbursement.Ensure the number of spinal regions treated aligns with the code reported.Consult payer-specific guidelines and policies to ensure compliance.

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