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CPT Codes & Modifiers for Chiropractic Insurance

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In chiropractic care, accepting insurance can be beneficial to both patients and practitioners alike. Enabling patients to utilize their insurance benefits of pay for services, results in an increase in new clients for your business, as well as better long-term relationships as clients continue to leverage their insurance. 

In this article, we’re helping chiropractors navigate the insurance billing process. We’ve compiled a list of the most commonly used CPT and modifier codes for chiropractors, as well as our best practices for insurance billing within your business. Utilize this guide to help you streamline your billing procedures and ensure a successful claims submission and reimbursement process.  

Benefits of Chiropractic Insurance Billing 

When looking to expand your client base, becoming in-network with insurance can help you reach new clients.  Clients looking for a new provider will often turn to their coverage to find who will and will not accept their insurance.  You will come up as an in-network provider, and clients will be more likely to consider working with you.  Accepting insurance also increases patient loyalty; accepting insurance ensures financial stability for clients, especially over long periods of time.  

Additionally, accepting insurance in your practice allows you to broaden your client base to include patients who rely entirely on insurance to pay for medical services. You’ll find that your practice can expand its reach within your community, to deliver care to patients who need it.

Getting Started with CPT Codes and Modifiers

CPT codes for chiropractors have been established and are maintained by the American Medical Association.  These five alpha-numeric character codes are used to describe all of the medical services rendered to patients or clients by a chiropractor for insurance purposes.  While three categories of CPT codes exist, most chiropractors mainly use Category I.  Category I codes are used for services rendered by healthcare providers in both in and outpatient settings.  

The CPT code you choose will indicate the services rendered, but in certain cases, you must add a modifier code as well. These modifier codes allow you to alert the insurance company that the services rendered were slightly altered from what the CPT code describes.  If your selected CPT code requires a modifier but you fail to include it, your claim will be rejected by the insurance company.  The two most commonly used modifier codes for chiropractors are:

  • 25: “significant, separately identifiable evaluation and management [E/M] service by the same physician on the same day of the procedure or other service”
  • 59: “a procedure or service was distinct or independent from other non-E/M services performed on the same day”

These modifier codes will ensure that you receive the maximum reimbursement for your services.  

List of Chiropractic CPT Codes

For chiropractors, CPT codes are an essential part of the billing process; they indicate to the insurance company exactly what procedures were performed and what the provider would like to be reimbursed for. 

While other medical providers may use a wide range of CPT codes, there are four main codes for chiropractors, with each indicating the region of the spine that was treated:

  • CPT Code 98940 Chiropractic manipulative treatment (CMT); Spinal, 1-2 regions
  • CPT Code 98941 Chiropractic manipulative treatment (CMT); Spinal, 3-4 regions
  • CPT Code 98942 Chiropractic manipulative treatment (CMT); Spinal, 5 regions
  • CPT Code 98943 Chiropractic manipulative treatment (CMT); Extraspinal, 1 or more regions

Be sure to be extremely clear on your form the proper amount of regions treated.  Using CPT code 98942, which would indicate 5 regions treated, but only documenting treatment in 3-4 regions will result in a rejection of the claim from the insurance company.   

Here is a list of the other most commonly used CPT codes for chiropractors, which include other treatments and appointment types:

  • CPT Code 99202 – Evaluation and Management, Initial Visit
  • CPT Code 99203 – Evaluation and Management, Initial Visit
  • CPT Code 99204 – Evaluation and Management, Initial Visit
  • CPT Code 99212 – Evaluation and Management, Established Patient
  • CPT Code 99213 – Evaluation and Management, Established Patient
  • CPT Code 99214 – Evaluation and Management, Established Patient
  • CPT Code 97140 – Manual Therapy
  • CPT Code 97110 – Therapeutic Exercise
  • CPT Code 97750 – Physical Performance Examination
  • CPT Code 99211 – Re-evaluation
  • CPT Code 97112 – Neuromuscular Re-education
  • CPT Code 97530 – Therapeutic Activities
  • CPT Code 97010 – Hot/Cold Packs
  • CPT Code 97014 – Electrical Stimulation (Unattended)
  • CPT Code 97035 – Ultrasound/Phonophoresis
  • CPT Code 97161 – PT Evaluation: Low Complexity
  • CPT Code 97116 – Gait Training
  • CPT Code 97162 – PT Evaluation: Moderate Complexity
  • CPT Code 97535 – Self Care/Home Management Training
  • CPT Code 97032 – Electrical Stimulation (Manual)
  • CPT Code 97012 – Mechanical Traction
  • CPT Code 97113 – Aquatic Exercise
  • CPT Code 97124 – Massage
  • CPT Code 97018 – Paraffin Bath
  • CPT Code 97022 – Whirlpool
  • CPT Code 97026 – Infrared Light
  • CPT Code 97033 – Iontophoresis
  • CPT Code 97039 – Laser/Other
  • CPT Code 72020 – Radiologic examination, spine, single view, specify level
  • CPT Code 72040 – Radiologic examination, spine, cervical; two or three views
  • CPT Code 72070 – Radiologic examination, spine; thoracic, two views
  • CPT Code 72072 – Radiologic examination, spine; thoracic, three views
  • CPT Code 72100 – Radiologic examination, spine, lumbosacral; two or three views
  • CPT Code 72170 – Radiologic examination, pelvis; one or two views
  • CPT Code 72190 – Radiologic examination, pelvis; complete, minimum of three views
  • CPT Code 72200 – Radiologic examination, sacroiliac joints; less than three views
  • CPT Code 72220 – Radiologic examination, sacrum and coccyx; minimum of two views

Best Practices for Using Chiropractic CPT Codes And Modifiers

Verify your clients’ benefits 

The benefits check is the critical point in time to learn if your client is covered, for which services, how many sessions are they covered for, and if there are any client-owed responsibilities. Collecting this information upfront will help to reduce claims denials, and also allow you to be transparent with your client.  

A common question is if you need a referral from a medical doctor for each client you see. The simple answer is: no. However, some insurance plans may only cover sessions with a referral. This should be shared by the representative when you call to verify benefits. 

Finally, some policy plans may require approval prior to your session before they will cover for services. If this is the case, then the insurance payer will state the requirements that the client must obtain (ie. documented form from MD). Once met, you’ll be given a prior authorization number to include in the CMS 1500 claim.

Leverage chart notes for proper documentation

Keeping good records is vital for every business, and in chiropractic practices, this includes storing client chart notes and paperwork.  Chart notes should be specific and detailed, including the need for treatment, the objectives of treatment, how you will measure client progress, the actual progress made, and the overall treatment plan.  Not only will complete chart notes help provide more effective treatment, but they will also support you when billing for insurance.  You will have easy access to specific information on each session.  

Additionally, keeping proper records will prepare you in case of an insurance audit.  Although this number may vary per insurance company and/or state, it’s generally required to store and maintain chart notes for at least 9 years. Failure to keep your files can lead to inspections by the FBI or other legality organizations that can ultimately close your business if demanded. This is why it’s vital to really understand the importance of keeping files on record for years to come to prevent any risk of being audited or getting yourself in any other legal situation. 

Tip: Healthie’s cloud-based EHR allows you to organize your chart notes and client paperwork securely, by keeping data encrypted and stored in multiple locations.

Be tedious when filling out your insurance claims

Much of the time, denied insurance claims are avoidable by ensuring the forms are filled out correctly.  Start by collecting all of the necessary information from your client to streamline the claims process, including basic client information and demographics, insurance information, diagnoses, and referring provider information (NPI and qualifier code). 

Next, be sure you also have the required provider information, including NPI, service location, and In-Network ID.   If you’ve already verified your client’s benefits, you can select the correct CPT and modifier codes, and fill out your form.  Read through the form thoroughly to ensure all of the information is correct and specific to avoid any denied claims. 

One way to be extremely cautious when submitting claims is to use a clearinghouse to scrub your claims.  Clearinghouses are intermediaries that forwards claim information from healthcare providers to insurance payers. When they scrub your claims, it simply means that they will scan the claim and notify you if there are any obvious errors.  Aside from scrubbing your claims, a clearinghouse is an important tool for streamlining insurance billing within your practice. 

Benefits of Healthie for Insurance Billing 

As you get started with Insurance billing, it’s important to have the right tools in place. Running an insurance-based practice can be a rewarding and profitable business. Healthie’s HIPAA-compliant insurance billing features support chiropractors by minimizing the time needed to create and monitor insurance claims, while also helping to ensure accurate claim submission to reduce claim rejections.

With Healthie, your insurance-based business benefits by features designed for your practice, including:

  • EHR with charting templates for health professionals
  • Automated electronic new client paperwork, including common chiropractic assessment forms 
  • Easily collect and store client insurance information
  • E-Fax with the ability to send and receive documents
  • Store credit card information to charge or invoice for copays, deductibles and other client owed responsibilities
  • Create Superbills and CMS-1500 claims
  • Easily send claims to Office Ally
  • Billing reports helping you reconcile your insurance claims and received payments

Make more time to grow your business.

Use a platform that automates the administrative, so you can focus on growth and care.

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