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.
