Chiropractic Services: Overview of Coverage and Documentation Requirements

Published 10/10/2018

This Comparative Billing Report (CBR) focuses on chiropractic services. CBR information is one of the many tools used to assist individual providers to become proactive in addressing potential billing issues and performing internal audits to ensure compliance with Medicare coverage guidelines.

For your personalized Chiropractic Services code family (CPT codes 98940-98942) eCBR results Logon to eServices.

Coverage of chiropractic services is specifically limited to treatment by means of manual manipulation (i.e., by use of the hands) of the spine to correct a subluxation. Subluxation is defined as a motion segment, in which alignment, movement integrity, and/or physiological function of the spine, are altered, although contact between joint surfaces remains intact.

Manual devices (those that are hand-held with the thrust of the force of the device being controlled manually) may be used by chiropractors in performing manual manipulation of the spine. Additional payment is not permitted for use of the device, and Medicare does not allow for an extra charge for the device itself.

Chiropractic Services (CPT Codes 98940-98942): Documentation Requirements

CPT Code
Spinal Area/Regions
Number of Regions Manipulated
Documentation Requirements
98940
Five spinal regions:
  • Cervical – occiput,C1-C7
  • Thoracic – T1-T12
  • Lumbar - L1-L5
  • Pelvis – ilia, right and left
  • Sacral – Sacrum, Coccyx 
One or two
  • Pre manipulation assessment (ex. review of imaging, physical examination documentation )
  • Response/Outcomes to Treatment
  • Plan for Ongoing Care
98941
Five spinal regions:
  • Cervical – occiput,C1-C7
  • Thoracic – T1-T12
  • Lumbar - L1-L5
  • Pelvis – ilia, right and left
  • Sacral – Sacrum, Coccyx 
Three to four
  • Pre manipulation assessment (ex. review of imaging, physical examination documentation )
  • Response/Outcomes to Treatment
  • Plan for Ongoing Care
98942
Five spinal regions:
  • Cervical – occiput,C1-C7
  • Thoracic – T1-T12
  • Lumbar - L1-L5
  • Pelvis – ilia, right and left
  • Sacral – Sacrum, Coccyx 
Five
  • Pre manipulation assessment (ex. review of imaging, physical examination documentation )
  • Response/Outcomes to Treatment
  • Plan for Ongoing Care

No other diagnostic or therapeutic service furnished by a chiropractor or under the chiropractor’s order is covered by Medicare. Additionally, if the ‘AT’ HCPCS modifier is used when billing a claim for a chiropractic service, it is the provider’s attestation that the treatment is active treatment and not maintenance therapy. Based on data analysis and the Office of Inspector General (OIG) reports, providers do not always use the ‘AT’ HCPCS modifier appropriately when filing claims to Medicare. To learn more, please visit the OIG website at www.OIG.HHS.Gov.

Additionally, claims submitted to Railroad Medicare for CPT codes 98940, 98941, and 98942, billed with both the 'AT' and 'GA' HCPCS modifier on the same detail line, will reject. Rejected claims do not have appeal rights and should be resubmitted with appropriate corrections.

Methods
The metrics reviewed in this report are the proportion of billing for each HCPCS code in the grouping with comparisons to peers with the same specialty in the national jurisdiction of Railroad Medicare. This report is an analysis of Medicare Part B claims extracted from the Palmetto GBA Railroad Medicare data warehouse. For the purpose of this CBR, 'peer groups' are defined as other providers in the Railroad Medicare database who have the same specialty.

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Example of eCBR

Education Resources:
The Railroad Medicare Provider Outreach and Education (POE) team has published a Web-Based Training (WBT) module to address the issues pertinent to Medicare chiropractic billing and coverage.

References and Resources

CMS Resources: