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 PolicyUnless 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
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.
To report CMT, the healthcare record must clearly indicate a subluxation exists. Documentation must substantiate the subluxation by one of two methods:
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.
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. |
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Spinal Manipulations
Includes CPT codes:
5 spinal regions include:
Extraspinal Manipulations
Includes CPT code:
5 extraspinal regions include:
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