Documentation to Support Spinal Manipulation for CPT Code 98942

It is not uncommon for chiropractic doctors to perform a full-spine or multi-level manipulation, even when the symptoms or diagnosis reflect a single region. This is a matter of technique and individual style. However, this is often in conflict with national Medicare regulations which require all services to be reasonable and necessary. Thus, to substantiate Medicare payment of CPT code 98942 – CMT; spinal, 5 regions; the precise level of subluxation(s) in five regions must be specified in the documentation. The level of the spinal subluxation(s) must bear a direct causal relationship to the patient’s symptoms, and the symptoms must be directly related to the level of the subluxation(s) that has been diagnosed. For Medicare payment to be made for spinal manipulation, the services must be reasonable and medically necessary in each region treated.

The frequency and duration of chiropractic treatment must be medically necessary and based on the individual patient’s condition and response to treatment. As with any medical service, there must be appropriate and legible documentation to support the billing. When services are preformed and billed in a manner suggesting inappropriate or excessive utilization, they may be subject to review for medical necessity.

Reviewed 9/11/2024