chiropractic manipulative therapies

When performed and billed to a payor, the medical necessity for chiropractic manipulation therapies must be clearly documented in the patient's health record and must be consistent with the chief complaint, clinical findings, diagnoses and treatment plan.

All CMT services provided and billed through HNS must be consistent with HNS and contracted payor policies, the policies of applicable state licensing boards as well as state and federal laws.

CMT include a pre-manipulation patient assessment and includes a review of radiographs,
interpretation of test results, treatment planning, pre-manipulation procedures, manipulation,
chart documentation and counseling.

CMT Documentation must include clinical information to clearly support the necessity for the level of manipulation reported to the payor.

CMT Documentation must indicate the specific segments/areas manipulated. There are two ways in which the level of subluxation may be specified:

1. The exact bones may be listed, for example: C5, C6, etc.

2. The area may be reported if it implies only certain bones such as: Occipital-atlantal (occiput and C1 (atlas)), lumbo-sacral (L5 and sacrum), sacro-iliac (sacrum and ilium).

To report CMT to HNS contracted payors, subluxations must be demonstrated, and must be demonstrated by one of two methods: x-ray or physical examination. 

Specific documentation requirements apply whether the subluxation is demonstrated by x-ray or by physical examination.

To demonstrate a subluxation based on a physical examination, two of the four criteria below
are required, one of which MUST be asymmetry/misalignment or range of motion
abnormality.

1. Pain/tenderness evaluated in terms of location, quality and intensity

2. Asymmetry/misalignment identified on a sectional or segmental level

3. Range of motion abnormalities (changes in active, passive, and accessory joint movements resulting in an increase or decrease of sectional or segmental
mobility)

4. Tissue changes in the characteristics of contiguous, or associated soft tissues; including skin, fascia, muscle, and ligament

CMT Documentation must clearly reflect the CMT service rendered.

Regardless of how many manipulations are performed in a given spinal region, (cervical, thoracic, etc.) it counts as only ONE region under the CMT codes.

Spinal Manipulations
Includes CPT codes:

98940 – CMT – spinal, one to two regions
98941 – CMT – spinal, three to four regions
98942 – CMT – spinal, five regions

5 spinal regions include:

Cervical Region– includes all manipulations performed to the atlanto-occipital joint and C1- C7.

Thoracic Region– includes all manipulations performed to T1-T12 including posterior ribs (costovertebral and costotransverse joints).

Lumbar Region – includes all manipulations performed to L1-L5.

Sacral Region includes all manipulations performed on the sacrum, including the
sacrococcygeal junction.

Pelvic Region – includes all manipulations performed to the sacro-iliac joints and other pelvic articulations.

Extraspinal Manipulations Includes CPT code:

98943 – Extraspinal - one or more regions

5 extraspinal regions include:
Head - includes all manipulations performed to the head, including TMJ, but excludes
atlanto-occipital joint.

Lower extremities – includes all manipulations performed to the hip, leg, knee, ankle and foot during any visit.

Upper extremities - includes all manipulations performed to the shoulders, arm, elbow, wrist, and hand during any visit.

Rib cage - includes all manipulations performed to the anterior rib cage on any given visit but excludes costovertebral and costotransverse joints.

Abdomen