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

 

 HNS Policy 

 

Unless the member’s healthcare plan includes maintenance care as a covered benefit, when performed and billed to a payor, the medical necessity for chiropractic manipulation therapies must be clearly documented in the patient’s healthcare 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 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:

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

  • 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, the healthcare record must clearly indicate a subluxation exists.  Documentation must substantiate the subluxation 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 for any visit.

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

  • Lumbar Region – includes all manipulations performed to L1-L5 on any visit. 

  • Sacral Region – includes all manipulations performed on the sacrum, including the sacrococcygeal junction, on any given visit. 

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

 

 

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