The observed an increasing number of denied Evaluation and Management (E&M) claims (99201-99215) when billed concurrently with chiropractic manipulation procedures, including chiropractic manipulative therapy (CMT), highlighting the potential for increased claim denials with Chiropractic Manipulative Therapy (CMT).
Denial Reasons & Misconceptions:
Common denial reasons include:
- “Service billed is included in another procedure billed the same day.” This often stems from a misunderstanding that the pre- and post-manipulation assessments inherent in CMT encompass the necessary physician evaluation.
- “Service is part of a post-operative service.” This is particularly concerning from California Blue Shield and is factually incorrect in most cases.
Importance of Proper Evaluation:
- Medical necessity dictates that a thorough patient examination is crucial to determine the appropriate course of care.
- Physicians should be compensated for this essential evaluation, separate from the treatment provided.
First Line of Defense: Modifier 25
- Appending Modifier 25 to the E&M code signifies a “significant, separately identifiable evaluation and management service” beyond the typical pre- and post-manipulation assessments associated with CMT.
- Always verify that modifier 25 was included on the original claim. Resubmit with the modifier if it was omitted.
Appeal Process:
- Standard Appeal Letter:
- Clearly state that the E&M service was distinct and separate from the routine pre- and post-manipulation assessments.
- Emphasize that modifier 25 was used to indicate this distinction.
- Include a copy of the original claim and detailed patient records to support the separate nature of the E&M service.
- Address specific denial reasons (e.g., “post-operative service”) directly.
- Consider Phone Appeals: For “post-operative service” denials, a phone call to provider relations may be effective.
Alternative Approach: Splitting Claims
- Submitting separate claims for the E&M service (with modifier 25) and the CMT procedure has been successful for some practices.
- Note: While not standard practice, this approach may circumvent systemic denial issues.
Disclaimer: This information is for general guidance only and does not constitute legal or financial advice. Consult with legal and billing experts for specific guidance tailored to your individual practice and payer contracts.
Chiropractic Manipulative Therapy (CMT) CPT Codes for 2025
For 2025, Chiropractic Manipulative Therapy (CMT) codes primarily fall under the CPT® (Current Procedural Terminology) code set. These codes are used for chiropractic services involving hands-on spinal manipulation to treat musculoskeletal conditions. Here are the commonly used codes in 2025, along with a brief overview of each.
It’s important to note that accurate and appropriate coding is crucial to avoid claim denials with Chiropractic Manipulative Therapy (CMT) and ensure proper reimbursement.
CPT Code 98940
- Description: Chiropractic manipulative treatment (CMT); spinal, 1-2 regions
- Usage: This code is used for a CMT treatment when one or two spinal regions are manipulated.
CPT Code 98941
- Description: Chiropractic manipulative treatment (CMT); spinal, 3-4 regions
- Usage: This code is used when three or four spinal regions are involved in the manipulation.
CPT Code 98942
- Description: Chiropractic manipulative treatment (CMT); spinal, 5 regions
- Usage: This code is used when five spinal regions are manipulated.
CPT Code 98943
- Description: Chiropractic manipulative treatment (CMT); extraspinal, 1 or more regions
- Usage: This code is used when the treatment involves manipulation of areas other than the spine, such as the extremities.
Streamline Chiropractic Billing: Outsourcing CMT Billing Services
Are you a chiropractic practice struggling with the complexities of Chiropractic Manipulative Therapy (CMT) billing? Managing the billing process efficiently is essential to ensure timely reimbursement and minimize claim denials with Chiropractic Manipulative Therapy (CMT).
A Chiropractic Manipulative Therapy billing company can help streamline your practice’s revenue cycle by handling all aspects of billing, coding, and claim management.
Benefits of Outsourcing CMT Billing Services
Outsourcing your chiropractic billing to a dedicated company allows you to:
- Improve Operational Efficiency: A professional team manages your claims processing, ensuring quicker payments and better cash flow.
- Expertise in Chiropractic Codes: Accurate use of codes, such as CPT 98940-98942 for CMT services, minimizes coding errors and maximizes reimbursements.
- HIPAA Compliance: Chiropractic billing companies adhere to HIPAA regulations, protecting patient data while ensuring your practice stays compliant.
Get Help with Chiropractic Billing
With a Chiropractic Manipulative Therapy billing company by your side, you can improve the financial health of your practice while focusing on providing quality care. By outsourcing your CMT billing, you can significantly reduce claim denials with Chiropractic Manipulative Therapy (CMT), leading to improved cash flow and overall practice profitability. Whether you’re dealing with Medicare, Medicaid, or private insurance providers, outsourcing ensures that your CMT billing is managed accurately and efficiently.
Let the experts handle the billing while you concentrate on patient outcomes. Contact us today to learn how we can optimize your practice’s revenue cycle and reduce billing headaches.