CMT is a form of
manual treatment to influence joint and neurophysiological function.
When similar or identical procedures are performed, but are qualified by an
increased level of complexity:
- Only the definitive or most
comprehensive service performed should be reported
- Only one CMT service of the
spinal region (procedures 98940-98942) or extraspinal region (98943) is
eligible for payment on a single date of service.
- Payment is limited to one
clinically indicated and medically necessary physical medicine modality or
procedure code per patient, per date of service.
- Payment is allowed for one clinically
indicated and medically necessary extraspinal manipulation code (i.e.,
98943-51) in combination with a spinal manipulation code (i.e., 98940,
98941, or 98942) per date of service.
The chiropractic
manipulative treatment codes include a pre-manipulation patient assessment.
Additional E/M services may be reported separately using modifier 25, if the
member’s condition requires a significant separately identifiable E/M service,
above and beyond the usual pre-service and post-service work associated with
the procedure.
When multiple procedures are performed at the same session by the same
provider, the modifier 51 may be appended to the additional CPT codes
(excluding E/M codes).
Refer to the Chiropractic Modalities section for a complete listing of CPT
physical medicine modality and procedure codes
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